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Pediatric Nephrology
Published in: Pediatric Nephrology 6/2017

01-06-2017 | Original Article

Endothelial dysfunction during long-term follow-up in children with STEC hemolytic-uremic syndrome

Authors: Martin Kreuzer, Laura Sollmann, Stephan Ruben, Maren Leifheit-Nestler, Dagmar-Christiane Fischer, Lars Pape, Dieter Haffner

Published in: Pediatric Nephrology | Issue 6/2017

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Abstract

Background

Shiga-toxin-producing Escherichia coli (STEC)-associated hemolytic-uremic syndrome (HUS) is a major cause of acute kidney injury (AKI), especially in children. Its long-term outcome with respect to endothelial damage remains largely elusive.

Methods

This was a cross-sectional study in 26 children who had suffered from STEC-HUS in the past and achieved a complete recovery of renal function (eGFR >90 ml/min/1.73 m2). Skin microcirculation after local heating was assessed by laser Doppler fluximetry, carotid-femoral pulse wave velocity (PWV), carotid intima media thickness (cIMT), 24-h ambulatory blood pressure, and angiopoietin (Ang) 1 and 2 serum levels after a median follow-up period of 6.1 years. The results were compared to those of healthy controls.

Results

All patients were normotensive, mean eGFR was 102 (range 91–154) ml/min/1.73 m2, and 13 of the 26 patients showed albuminuria. Endothelial dysfunction was present in 13 patients, and the mean serum Ang2/Ang1 ratio was increased compared to healthy children (each p < 0.05). In contrast, mean values for PWV and cIMT in the patients did not differ from those of the controls. Endothelial dysfunction was significantly associated with younger age at STEC-HUS manifestation, time after HUS, and presence of albuminuria.

Conclusion

The results of this study highlight the need for long-term follow-up of STEC-HUS patients even after complete recovery of eGFR and lack of hypertension with respect to microvascular damage.
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Metadata
Title
Endothelial dysfunction during long-term follow-up in children with STEC hemolytic-uremic syndrome
Authors
Martin Kreuzer
Laura Sollmann
Stephan Ruben
Maren Leifheit-Nestler
Dagmar-Christiane Fischer
Lars Pape
Dieter Haffner
Publication date
01-06-2017
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 6/2017
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-016-3574-3

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