An international consensus approach to the management of atypical hemolytic uremic syndrome in children

Chantal Loirat, Fadi Fakhouri, Gema Ariceta, Nesrin Besbas, Martin Bitzan, Anna Bjerre, Rosanna Coppo, Francesco Emma, Sally Johnson, Diana Karpman, Daniel Landau, Craig B. Langman, Anne Laure Lapeyraque, Christoph Licht, Carla Nester, Carmine Pecoraro, Magdalena Riedl, Nicole C A J van de Kar, Johan Van de Walle, Marina VivarelliVéronique Frémeaux-Bacchi

Research output: Contribution to journalArticle

Abstract

Atypical hemolytic uremic syndrome (aHUS) emerged during the last decade as a disease largely of complement dysregulation. This advance facilitated the development of novel, rational treatment options targeting terminal complement activation, e.g., using an anti-C5 antibody (eculizumab). We review treatment and patient management issues related to this therapeutic approach. We present consensus clinical practice recommendations generated by HUS International, an international expert group of clinicians and basic scientists with a focused interest in HUS. We aim to address the following questions of high relevance to daily clinical practice: Which complement investigations should be done and when? What is the importance of anti-factor H antibody detection? Who should be treated with eculizumab? Is plasma exchange therapy still needed? When should eculizumab therapy be initiated? How and when should complement blockade be monitored? Can the approved treatment schedule be modified? What approach should be taken to kidney and/or combined liver–kidney transplantation? How should we limit the risk of meningococcal infection under complement blockade therapy? A pressing question today regards the treatment duration. We discuss the need for prospective studies to establish evidence-based criteria for the continuation or cessation of anticomplement therapy in patients with and without identified complement mutations.

Original languageEnglish
Pages (from-to)15-39
Number of pages25
JournalPediatric Nephrology
Volume31
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

Keywords

  • Anti-factor H antibody
  • Atypical hemolytic uremic syndrome
  • Children
  • Combined liver–kidney transplantation
  • Complement
  • Eculizumab
  • Hemolytic uremic syndrome
  • Kidney transplantation
  • Plasma exchange
  • Plasma infusion
  • Thrombotic microangiopathy

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

Fingerprint Dive into the research topics of 'An international consensus approach to the management of atypical hemolytic uremic syndrome in children'. Together they form a unique fingerprint.

  • Cite this

    Loirat, C., Fakhouri, F., Ariceta, G., Besbas, N., Bitzan, M., Bjerre, A., Coppo, R., Emma, F., Johnson, S., Karpman, D., Landau, D., Langman, C. B., Lapeyraque, A. L., Licht, C., Nester, C., Pecoraro, C., Riedl, M., van de Kar, N. C. A. J., Van de Walle, J., ... Frémeaux-Bacchi, V. (2016). An international consensus approach to the management of atypical hemolytic uremic syndrome in children. Pediatric Nephrology, 31(1), 15-39. https://doi.org/10.1007/s00467-015-3076-8