Eculizumab use in patients with pneumococcal-associated hemolytic uremic syndrome and kidney outcomes

Background Streptococcus pneumoniae -associated hemolytic uremic syndrome (P-HUS) is a rare and severe disease.

Only a few reports have been published about eculizumab use in P-HUS.

Methods We analyzed demographic, clinical, and laboratory data of patients with P-HUS from our center.

Results The cohort consisted of 4 females and 3 males.

All patients had pneumonia.

Four were given eculizumab (days 1–3).

The eculizumab group required a shorter duration of dialysis and mechanical ventilation (medians 20 vs. 28.5 and 30 vs 38.5 days, respectively) compared with the non-eculizumab group, but this was still much longer than normally reported; the thrombocytopenia resolution was similar in both groups (medians 10 vs. 8 days).

Chronic kidney disease (CKD) was correlated with the duration of dialysis and mechanical ventilation duration at 1 year ( r  = 0.797, P  = 0.032 and r  = 0.765, P  = 0.045) and last follow-up ( r  = 0.807, P  = 0.028 and r  = 0.814, P  = 0.026, respectively); our scoring system showed even stronger correlations ( r  = 0.872, P  = 0.011 and r  = 0.901, P  = 0.0057, respectively).

The eculizumab group showed slightly better 1-year and last follow-up CKD stage (2.75 vs. 3, P  = 0.879 and 2.5 vs. 3.67, P  = 0.517).

Conclusions Despite the fact that the eculizumab group showed better outcomes, eculizumab does not seem to improve the course of P-HUS compared with previous reports.

Kidney outcomes are strongly correlated with the duration of dialysis and mechanical ventilation duration.

Graphical Abstract A higher resolution version of the Graphical abstract is available as Supplementary information