Relationship of the Recovery in the Glomerular Filtration Rate to the Duration of Anuria in Diarrhea-Associated Hemolytic Uremic Syndrome

Robson, Wm. Lane M.; Leung, Alexander K. C; Brant, Rollin

doi:10.1159/000168617

Cited by 14 publications

(12 citation statements)

References 8 publications

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“…Oligoanuria or its duration during HUS is associated with worse outcomes [6][7][8][9][10][11][12][13][14] and should be avoided. 15 At our institutions, we encourage starting intravenous isotonic volume expansion as early as possible in E coli O157:H7 infections, even before culture results are known.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Oligoanuric renal failure during HUS usually necessitates dialysis and lengthens hospitalization; its occurrence and duration are risk factors for chronic sequelae. [6][7][8][9][10][11][12][13][14][15] Ideally, the oligoanuric form of HUS should be prevented, because oligoanuria seems to represent a more severe form of renal injury.Vascular injury and prothrombotic coagulation abnormalities, such as thrombin generation, fibrinolysis inhibition, intravascular fibrin accretion, 3 elevated circulating platelet activating factor, 16 and degraded von Willebrand factor multimers, 17 precede renal injury in infected children. These findings suggest that vascular occlusion, a process that conceivably could be attenuated by volume expansion, at least partly underlies renal insufficiency during HUS.…”

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confidence: 99%

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confidence: 99%

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Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

et al. 2005

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ABSTRACT. Objective. The hemolytic uremic syndrome (HUS) consists of hemolytic anemia, thrombocytopenia, and renal failure. HUS is often precipitated by gastrointestinal infection with Shiga toxin-producing Escherichia coli and is characterized by a variety of prothrombotic host abnormalities. In much of the world, E coli O157:H7 is the major cause of HUS. HUS can be categorized as either oligoanuric (which probably signifies acute tubular necrosis) or nonoligoanuric. Children with oligoanuric renal failure during HUS generally require dialysis, have more complicated courses, and are probably at increased risk for chronic sequelae than are children who experience nonoligoanuric HUS. Oligoanuric HUS should be avoided, if possible. The presentation to medical care of a child with definite or possible E coli O157:H7 infections but before HUS ensues affords a potential opportunity to ameliorate the course of the subsequent renal failure. However, it is not known whether events that occur early in E coli O157:H7 infections, particularly measures to expand circulating volume, affect the likelihood of experiencing oligoanuric HUS if renal failure develops. We attempted to assess whether pre-HUS interventions and events, especially the volume and sodium content of intravenous fluids administered early in illness, affect the risk for developing oligoanuric HUS after E coli O157:H7 infections.Methods. We performed a prospective cohort study of 29 children with HUS that was confirmed microbiologically to be caused by E coli O157:H7. Infected children were enrolled when they presented with acute bloody diarrhea or as contacts of patients who were known to be infected with E coli O157:H7, or if they had cultureconfirmed infection, or if they presented with HUS. HUS was defined as hemolytic anemia (hematocrit <30%, with fragmented erythrocytes on peripheral-blood smear), thrombocytopenia (platelet count of <150 000/mm 3 ), and renal insufficiency (serum creatinine concentration that exceeded the upper limit of normal for age). A wide range of pre-HUS variables, including demographic factors, clinical history, medications given, initial laboratory values, and volume and content of parenteral fluid administered, were recorded and entered into analysis. Estimates of odds ratios were adjusted for possible confounding effects using logistic regression analysis. Twenty-nine children who were <10 years old, had HUS confirmed to be caused by E coli O157:H7, and were hospitalized at the Children's Hospital and Regional Medical Center, Seattle, were studied. The main outcome measured was development of oligoanuric renal failure. Oligoanuria was defined as a urine output <0.5 mL/kg per hour for at least 24 consecutive hours.Results. As a group, the children with oligoanuric renal failure presented to medical attention and were evaluated with laboratory testing later than the children with nonoligoanuric renal failure. On initial assessments, the children with oligoanuric outcomes had higher white blood cell counts, lower platelet counts...

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Section: Discussionmentioning

confidence: 99%

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Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

et al. 2005

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“…Many symptoms or clinical features have also been proposed as prognostic factors for HUS, but the results obtained in different studies were often controversial [1,2,14,15,16,17,18,19,20,21,22,23,24,25]. Moreover, to our knowledge, STEC infection is not usually considered a prognostic factor and the presence of D has generally been considered synonymous with the presence of STEC infection.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for poor renal prognosis in children with hemolytic uremic syndrome

Gianviti

Tozzi

Petris

et al. 2003

Pediatric Nephrology

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Many factors have been proposed as predictors of poor renal prognosis in children with hemolytic uremic syndrome (HUS), but their role is still controversial. Our aim was to detect the most reliable early predictors of poor renal prognosis to promptly identify children at major risk of bad outcome who could eventually benefit from early specific treatments, such as plasmapheresis. Prognostic factors identifiable at onset of HUS were evaluated by survival analysis and a proportional hazard model. These included age at onset, prodromal diarrhea (D), leukocyte count, central nervous system (CNS) involvement, and evidence of Shiga toxin-producing Escherichia coli (STEC) infection. Three hundred and eighty-seven HUS cases were reported; 276 were investigated for STEC infection and 189 (68%) proved positive. Age at onset, leukocyte count, and CNS involvement were not associated with the time to recovery. Absence of prodromal D and lack of evidence of STEC infection were independently associated with a poor renal prognosis; only 34% of patients D(-)STEC(- )recovered normal renal function compared with 65%-76% of D(+)STEC(+), D(+)STEC(-) and D(-)STEC(+ )patients. In conclusion, absence of both D and evidence of STEC infection are needed to identify patients with HUS and worst prognosis, while D(-) but STEC(+) patients have a significantly better prognosis.

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“…Hypertension during and after acute HUS is common, with up to 70% of patients affected (99). The mechanism of HUS-induced hypertension is multifactorial and likely related to volume overload and to endothelial and vascular injury.…”

Section: Hypertensionmentioning

confidence: 99%

Shiga Toxin/Verocytotoxin-Producing Escherichia coli Infections: Practical Clinical Perspectives

2014

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Escherichia coli strains that produce Shiga toxins/verotoxins are rare, but important, causes of human disease. They are responsible for a spectrum of illnesses that range from the asymptomatic to the life-threatening hemolyticuremic syndrome; diseases caused by E. coli belonging to serotype O157:H7 are exceptionally severe. Each illness has a fairly predictable trajectory, and good clinical practice at one phase can be inappropriate at other phases. Early recognition, rapid and definitive microbiology, and strategic selection of tests increase the likelihood of good outcomes. The best management of these infections consists of avoiding antibiotics, antimotility agents, and narcotics and implementing aggressive intravenous volume expansion, especially in the early phases of illness.

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Relationship of the Recovery in the Glomerular Filtration Rate to the Duration of Anuria in Diarrhea-Associated Hemolytic Uremic Syndrome

Cited by 14 publications

References 8 publications

Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

Relative Nephroprotection DuringEscherichia coliO157:H7 Infections: Association With Intravenous Volume Expansion

Risk factors for poor renal prognosis in children with hemolytic uremic syndrome

Shiga Toxin/Verocytotoxin-Producing Escherichia coli Infections: Practical Clinical Perspectives

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