Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome

Abstract

Prior long-term retrospective studies have described renal sequelae in 25-50 % of post diarrheal hemolytic uremic syndrome (D+HUS ) survivors, but the ability to predict the likelihood of chronic renal related sequelae at the time of hospital discharge is limited. We surveyed 357 children in our HUS registry who had survived an acute episode of D+HUS and were without end stage renal disease (ESRD) at the time of hospital discharge. Of the 357 patients surveyed, 159 had at least one year (mean 8.75 years) of follow-up. Of these, 90 individuals were identified as having had at least one day of oliguria, with 69 individuals having had at least one day of anuria. Incidence of renal related sequelae (proteinuria, low glomerular filtration rate [GFR], and hypertension) were determined among experimental groups based on the duration of oliguria and anuria. One or more sequelae (e.g. proteinuria, low GFR, hypertension) were seen in 25 (36.2%) of those who had no recorded oliguria and 34 (37.8%) of those with no recorded anuria. The prevalence of chronic sequelae increased markedly in those with more than 5 days of anuria or 10 days of oliguria; with anuria being a better predictor of most related sequelae than oliguria. A particularly high incidence of hypertension was seen in patients with > 10 days of anuria (55.6%) in comparison to those with no anuria (OR = 12.8; 95% CI = 2.9 to 57.5). Patients with > 10 days of anuria were also at substantially increased risk for low GFR and proteinuria (OR = 35.2; 95% CI = 5.1 to 240.5). These findings may help to identify children who need periodic and extended follow-up after discharge from the hospital.

Prevalence and clinical course of typical hemolytic uremic syndrome among sibling

“…[8][9][10] Between 20% and 30% of patients have longterm kidney sequelae, including proteinuria, high blood pressure, and a reduced glomerular filtration rate. 2,[10][11][12] Several studies have attempted to establish predictors of a poor prognosis in terms of mortality and kidney disease progression in patients with typical HUS.…”

“…2,[10][11][12] Several studies have attempted to establish predictors of a poor prognosis in terms of mortality and kidney disease progression in patients with typical HUS. 8,9 The studies conducted by Oakes et al in 2006 and demonstrated that leukocytosis and mild anemia at the time of admission to the hospital were associated with mortality, and the duration of oliguria and/or anuria were predictors of kidney morbidity in the long term. 8,9 In endemic regions, many family cases of HUS are caused by the Shiga toxin.…”

“…8,9 The studies conducted by Oakes et al in 2006 and demonstrated that leukocytosis and mild anemia at the time of admission to the hospital were associated with mortality, and the duration of oliguria and/or anuria were predictors of kidney morbidity in the long term. 8,9 In endemic regions, many family cases of HUS are caused by the Shiga toxin. Cases occurring in the second sibling appeared within 4 weeks in 3.4% of studied families in Utah, USA.…”

“…A severity score was established based on the mortality and chronic kidney involvement predictors described by Oakes et al 8,9 in 2006 and 2008: mm 3 or higher (1) and lower (0).…”

Di̇yare Öyküsü Olan Hemoli̇ti̇k Üremi̇k Sendrom Tanili Hastalarin Kli̇ni̇k Özelli̇kleri̇

“…Hastaların vücut ağırlıkları, kan basıncı ölçümleri, günlük sıvı alımları ve idrar miktarları takip edildi. İdrar miktarının <500 ml/1,73m 2 /gün olması oligüri olarak (6) ve < 15 ml/gün olması anüri olarak kabul edildi (7). Sistolik ve diastolik kan basıncı ölçümlerinin yaşa ve cinse göre >95th persantil olması hipertansiyon olarak tanımlandı (8).…”