The results of a controlled trial to ascertain the usefulness of plasma infusion for
the treatment of hemolytic-uremic syndrome (HUS) are reported. Criteria for admission
were (1) observation within 8 days from first symptoms, (2) dialysis treatment required,
and (3) no special treatments and no more than 25 ml blood/kg previously received.
Children were subdivided according to age (less than or more than 3 years) and then
randomly assigned to treatment with plasma or symptomatic therapy. Thirty-two children
ranging in age from 4 months to 6 years entered this study; 17 received plasma (P+
group) and 15 only symptomatic therapy (P- group). The mean follow-up period was 16
months in both groups. Surgical renal biopsy was performed 29 to 49 days after onset
in 11 P+ and 11 P- children, and 33 histologic findings were semiquantitatively evaluated.
No death occurred in either group. No differences were found in blood pressure, proteinuria,
or hematuria at the end of the follow-up period; in no case were severe arteriolar
lesions found. There were no significant differences for the scores of the individual
histologic measurements; on electron microscopy, no vascular changes were observed
in seven children of the P+ group, whereas in five of seven of the P- group, thickening
of the lamina rara interna and arteriolar damage were present. The ability of plasma
to stimulate prostacyclin (PGI2) production, measured as its stable derivative 6-keto-PGF1
alpha, was within the normal range for all patients. In our patients with predominant
glomerular involvement who were treated in a very early phase of HUS, infusions of
plasma did not significantly influence the short- and medium-term clinical outcome
and were not effective in severe HUS when given later in the course of the disease.
A longer follow-up is needed to ascertain whether the presence of endothelial damage,
demonstrated by electron microscopy in children who were not given plasma, is of clinical