Laboratory predictors of acute dialysis in hemolytic uremic syndrome

Balestracci, Alejandro; Martin, Sarah E.; Toledo, Ismael; Alvarado, Caupolicán; Wainsztein, Raquel Eva

doi:10.1111/ped.12245

Cited by 17 publications

(5 citation statements)

References 29 publications

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“…[9] Two thirds of patients required dialysis during acute stage. [13] In our cohort, half of the patient required intermittent hemodialysis similar with literature. Thrombocyte transfusions should be done in before surgical procedures or active bleeding in HUS patients.…”

Section: Discussionsupporting

confidence: 69%

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Assessment of Pediatric Hemolytic Uremic Syndrome Patients Hospitalized in Pediatric Intensive Care Unit

Özcan

TEHÇİ

Koçkuzu

et al. 2022

Journal of Contemporary Medicine

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Aim: It is aimed to describe clinical properties and outcomes of pediatric hemolytic uremic syndrome hospitalized in pediatric intensive care. Material and Method: Our study was intended as observatory and retrospective. Symptoms before PICU admission, interventions before PICU admission, time period before PICU admission in days were defined as pre-PICU findings. Glasgow Coma Score (GCS) at admission, Pediatric Risk of Mortality Score (PRİSM-III), laboratory parameters, medical treatments, extracorporeal treatments data was collected as PICU interventions. Outcomes were examined as days in PICU, days in hospital and survival. Results: Twenty-three patients were included into study. Before PICU admission more than half of the patients were treated with antibiotics. Twenty-two were suffered from diarrhea. 3 patients had non-bloody diarrhea. 3 patients had central nervous system involvement presented as seizures. Intravenous diuretics (86.9%) and oral antihypertensives (73.9%) were the most common treatments in PICU. Eculizumab treatment was required for 6 patients. All patients got fresh frozen plasma. Nearly all of the patients required erythrocyte transfusions (95.6%). If we evaluated renal replacement therapies, 2 (8.6%) patients needed CRRT and 12 (52.7%) patients needed IHD. Extrarenal involvement was spotted in 5 patients (21.7%). Most of the patients were survived (95.3%). Conclusion: Hemolytic uremic syndrome is an important clinic entity. Most patients’ blood pressure could be controlled with oral antihypertensive treatments. Antibiotic prescriptions to diarrhetic patients should be more cautiously. There should be transfusion protocols of clinics about HUS patients to prevent over transfusion.

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Section: Discussionsupporting

confidence: 69%

“…Management of D+ HUS is supportive therapy, appropriate fluid infusion, electrolyte management and blood pressure control. [13] Hypertension in HUS patient's is result of activation of renin-angiotensin-aldosterone system activation due to renal vascular thrombosis. [9] Hypertension is quite common in HUS patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Pediatric Hemolytic Uremic Syndrome Patients Hospitalized in Pediatric Intensive Care Unit

Özcan

TEHÇİ

Koçkuzu

et al. 2022

Journal of Contemporary Medicine

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“…In our previous study [ 14 ], the patient's age, time until hospitalization, circulating level of paraquat, estimated glomerular filtration rate at admission, and SOFA 48h score, but not AKIN 48h score, significantly predicted death after paraquat intoxication. Nevertheless, Balestracci et al [ 31 ] demonstrated that AKIN stage 3 at admission predicted AKI HD in patients with hemolytic uremic syndrome with a sensitivity of 92% and specificity of 84.2%. Furthermore, Kielstein et al [ 32 ] reported that the majority of patients undergoing interventional lung assist treatment and receiving extended hemodialysis were in AKIN stage 3.…”

Section: Discussionmentioning

confidence: 99%

Predictors of acute kidney injury after paraquat intoxication

Weng

Chen

et al. 2017

Oncotarget

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Paraquat intoxication is characterized by multi-organ failure, causing substantial mortality and morbidity. Many paraquat patients experience acute kidney injury (AKI), sometimes requiring hemodialysis. We observed 222 paraquat-intoxicated patients between 2000 and 2012, and divided them into AKI (n = 103) and non-AKI (n = 119) groups. The mortality rate was higher for AKI than non-AKI patients (70.1% vs. 40.0%, P < 0.001). Patients with AKI had a longer time to hospital arrival (P = 0.003), lower PaO2 (P = 0.006) and higher alveolar-arterial O2 difference (P < 0.001) 48 h after admission, higher sequential organ failure assessment 48-h score (P < 0.001), higher severity index of paraquat poisoning (SIPP) score (P = 0.016), lower PaCO2 at admission (P = 0.031), higher PaO2 at admission (P = 0.015), lower nadir PaCO2 (P = 0.001) and lower nadir HCO3 (P = 0.004) than non-AKI patients. Multivariate logistic regression indicated that acute hepatitis (P < 0.001), a longer time to hospital arrival (P < 0.001), higher SIPP score (P = 0.026) and higher PaO2 at admission (P = 0.014) were predictors of AKI. The area under the receiver operating characteristic curve confirmed that an Acute Kidney Injury Network 48-hour score ≥ 2 predicted AKI necessitating hemodialysis with a sensitivity of 0.6 and specificity of 0.832. AKI is common (46.4%) following paraquat ingestion, and acute hepatitis, the time to hospital arrival, SIPP score and PaO2 at admission were powerful predictors of AKI. Larger studies with longer follow-up durations are warranted.

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“…Diabetes was defined as glycemia >200 mg/dL treated with insulin 21 . Indications for dialysis were anuria lasting >24 hours, severe metabolic acidosis, advanced uremia, refractory electrolyte abnormalities, and hypervolemia 22 …”

Section: Methodsmentioning

confidence: 99%

Prodromal Phase of Hemolytic Uremic Syndrome Related to Shiga Toxin–Producing Escherichia coli

et al. 2019

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Objectives: This study aimed to evaluate practice patterns during prodromal phase of hemolytic uremic syndrome related to Shiga toxin-producing Escherichia coli (STEC-HUS).Methods: Trajectories of children from first symptoms until STEC-HUS admitted consecutively at our center (period 2000-2017) were retrospectively reviewed. Early recommended practices include identification of STEC infections, antibiotics and antiperistaltic avoidance, and administration of anticipatory intravenous fluids; therefore, implementation and changes over time (before and after 2011) of such interventions were assessed. In addition, early management was correlated with acute disease outcomes.Results: Of 172 patients, 98 (57%) had early consults, 75 of them visit the pediatric emergency department. Those seen with watery diarrhea (n = 74) were managed as outpatients, whereas 27 of the 45 assisted with bloody diarrhea were hospitalized for diagnosis other than STEC-HUS. Stool cultures were performed in 13.4% (23/172), 18% (31/172) received antibiotics, and 12.8% (22/172) received endovenous fluids; none received antiperistaltic agents. Shiga toxin-producing E. coli infection was proven in 4% (7/172) before HUS. Rate of cultured patients and treated with intravenous fluids remained unchanged over time (P = 0.13 and P = 0.48, respectively), whereas antibiotic prescription decreased from 42.8% to 16.6% (P = 0.005). Main acute outcomes (need for dialysis, pancreatic compromise, central nervous system involvement, and death) were similar (P > 0.05) regardless of whether they received antibiotics or intravenous fluids.Conclusions: During the diarrheal phase, 57% of patients consulted; three-quarters of them consulted to the pediatric emergency department. Shiga toxin-producing E. coli detection was poor, antibiotic use remained high, and anticipatory volume expansion was underused. These findings outline the critical need to improve the early management of STEC-HUS.

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Laboratory predictors of acute dialysis in hemolytic uremic syndrome

Cited by 17 publications

References 29 publications

Assessment of Pediatric Hemolytic Uremic Syndrome Patients Hospitalized in Pediatric Intensive Care Unit

Assessment of Pediatric Hemolytic Uremic Syndrome Patients Hospitalized in Pediatric Intensive Care Unit

Predictors of acute kidney injury after paraquat intoxication

Prodromal Phase of Hemolytic Uremic Syndrome Related to Shiga Toxin–Producing Escherichia coli

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