Childhood hemolytic uremic syndrome is associated with adolescent-onset diabetes mellitus

Nesmith, J. Darrell; Ellis, Eileen N.

doi:10.1007/s00467-006-0305-1

Cited by 20 publications

(15 citation statements)

References 16 publications

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“…13 Diabetes was also reported as a complication of childhood Stx-HUS with negative diabetes mellitus autoantibodies. 24 We observed comparable symptoms between children and adults but a severer evolution in adults. This must be confirmed by a large cohort of adult cases.…”

Section: Discussionsupporting

confidence: 51%

Clinical Features of Anti-Factor H Autoantibody–Associated Hemolytic Uremic Syndrome

Dragon-Durey

Sethi²,

Bagga³

et al. 2010

Journal of the American Society of Nephrology

261

283

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Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy that associates, in 70% of cases, with genetic or acquired disorders leading to dysregulation of the alternative pathway of complement. Autoantibody directed against Factor H causes at least 6% to 10% of aHUS cases, but only a few clinical reports are available. Here, we describe the clinical, biologic, genetic features, treatment, and outcome of 45 patients who presented with aHUS associated with anti-FH autoantibody. We found that this form of aHUS primarily affects children between 9 and 13 years old but it also affects adults. It presents with a high frequency of gastrointestinal symptoms and with extrarenal complications and has a relapsing course. Activation of the alternative pathway of complement at the onset of disease portends a poor prognosis. Early specific treatment may lead to favorable outcomes. These data should improve the recognition and diagnosis of this form of aHUS and help identify patients at high risk of a poor outcome.

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Section: Discussionsupporting

confidence: 51%

Clinical Features of Anti-Factor H Autoantibody–Associated Hemolytic Uremic Syndrome

Dragon-Durey

Sethi²,

Bagga³

et al. 2010

Journal of the American Society of Nephrology

261

283

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“…4 Relapse after initial resolution has been reported to occur 3, 7, 10, and 11 years after the acute illness. [12][13][14]22 In our review, given that almost 50% of recovering children were followed for less than 1 year, the rate of permanent DM may in fact be higher than reported.…”

contrasting

confidence: 71%

“…[5][6][7][8][9][10][11][12] This does not seem to be immune-mediated, as pancreatic autoantibodies were negative in all of the related eight case reports. 5,[8][9][10][11][12][13][14] However, the pathophysiology is likely related to microangiopathy of pancreatic microvasculature, resulting in b-cell death. Indeed, Gb3 receptors, associated with toxin binding in the kidney, 15 do exist in the pancreas.…”

mentioning

confidence: 99%

Relationship between Escherichia coli O157:H7 and diabetes mellitus

Suri

Mahon

Clark

et al. 2009

Kidney International

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Ingestion of Escherichia coli O157:H7 can cause a spectrum of acute illness, ranging from overt hemolytic-uremic syndrome (HUS), to gastroenteritis with bloody diarrhea, to no symptoms. This organism has been responsible for dozens of outbreaks of gastroenteritis and HUS in industrialized nations, and thus is a major public health concern. Although the acute effects of E. coli O157:H7 ingestion are well understood, the long-term complications are less well known. Here, we review the biological and empirical evidence supporting a link between E. coli O157:H7 and long-term diabetes mellitus. Survivors with diarrhea-associated HUS have a significantly increased incidence of diabetes due to complete insulin deficiency, which may recur several years after the initial infection. However, less severe forms of infection, such as E. coli O157:H7 gastroenteritis without overt HUS, do not appear to result in an increased risk of type 2 diabetes.

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“…Diabetes recurrence after diabetes HUS has been reported previously after a short or long period of time only in sporadic HUS cases (that were not part of an outbreak), and most of the cases reported negative islet cell antibodies (Table ) . Bendel‐Stenzel reported two cases of diabetes recurrence after sporadic HUS who had also simultaneous pancreas–kidney transplant with subsequent good progress and insulin independence over 2 years follow‐up …”

Section: Discussionmentioning

confidence: 81%