TY  - JOUR
TI  - Hemoglobin cast nephropathy: a rare but serious complication of hemolysis in a pediatric patient
AB  - Background. Intravascular hemolysis is a serious and rare condition in children and causes the release of hemoglobin and heme into circulation, which have proinflammatory properties. These substances lead to inflammation, oxidative stress, apoptosis, and organelle dysfunction that lead to acute kidney injury (AKI). We report a pediatric case diagnosed with hemolysis-associated hemoglobin cast nephropathy due to autoimmune hemolytic anemia. Case. A 4-year-old boy, who was admitted to another hospital with complaints of fever and dark urine for one day, developed anemia and kidney failure in the follow-up, was referred to our hospital. In physical examination, pallor and icterus on the sclera were noted. The patient had low hemoglobin and haptoglobin levels concomitant with high levels of serum lactate dehydrogenase, urea and creatinine. A peripheral blood smear showed marked spherocytes without schistocytes. A kidney biopsy was performed due to ongoing overt hemolysis and dialysis requirement, which showed findings consistent with hemoglobin cast nephropathy. Although the initial polyspecific direct antiglobulin test (DAT) was negative, due to persistent intravascular hemolysis DAT was studied monospecifically and showed IgM antibody positivity. Therefore, a diagnosis of autoimmune hemolytic anemia was made, and corticosteroid treatment was started. Hemolysis immediately ceased and the need for erythrocyte transfusion and dialysis disappeared. Conclusions. Acute kidney injury associated with hemoglobin cast nephropathy is an extremely rare condition in childhood. Although the initial course is severe and potentially life-threatening, the prognosis is favorable with the treatment of the underlying cause and management of AKI. Therefore, pediatricians should be aware of this rare clinical entity during clinical practice.
AU  - Avcu Oral, Nihan
AU  - Orhan, Diclehan
AU  - Ozaltin, Fatih
AU  - Özcebe, Osman
AU  - Baltu, Demet
AU  - Kesici, Selman
AU  - Topaloglu, Rezan
AU  - Aksu, Tekin
DO  - 10.24953/turkjped.2022.1067
PY  - 2023
JO  - Turkish Journal of Pediatrics
VL  - 65
IS  - 5
SN  - 0041-4301
SP  - 874
EP  - 880
DB  - TRDizin
UR  - http://search/yayin/detay/1208016
ER  -