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

Abstract

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.

Shiga Toxins Present in the Gut and in the Polymorphonuclear Leukocytes Circulating in the Blood of Children with Hemolytic-Uremic Syndrome

“…Participants in the present study were 20 consecutive HUS patients (less than 15 years old) admitted during 2003 and 2004 to three pediatric hospitals (Ospedale Pediatrico Bambino Gesù, Rome; Ospedale Santobono, Naples; and Clinica Pediatrica De Marchi, Milan) participating in the Italian surveillance system of HUS (11,24). A case of HUS was defined according to the following diagnostic criteria: acute microangiopathic hemolytic anemia, thrombocytopenia (platelet count, Ͻ100,000 mm 3 ), and acute renal injury (11,24). The definition has been in place in the Registry since its start, and it is consistent with the majority of the international HUS studies.…”

A case of haemolytic uraemic syndrome (HUS) revealed an outbreak of Shiga toxin-2-producing Escherichia coli O26:H11 infection in a nursery, with long-lasting shedders and person-to-person transmission, Italy 2015

“…La stessa analisi è stata ripetuta stratificando i casi rispetto all'esito della diagnostica per STEC ed alla presenza o meno di diarrea prodromica. La combinazione di questi elementi costituisce un utile e semplice indicatore di prognosi (Gianviti, 2003).…”

Síndrome hemolítico urémico en Chile: presentación clínica, evolución y factores pronósticos

“…Varias publicaciones han asociado característi-cas clínicas y parámetros de laboratorio como predictores de mortalidad y evolución desfavorable desde el punto de vista renal, pero sus resultados continúan siendo controvertidos [7][8][9][10] .…”