Top

Pediatric Nephrology

Published in:

03-01-2023 | Escherichia Coli | Original Article

Long-term kidney outcomes in non-dialyzed children with Shiga-toxin Escherichia coli associated hemolytic uremic syndrome

Authors: Laura F. Alconcher, Lucas I. Lucarelli, Sabrina Bronfen

Published in: Pediatric Nephrology | Issue 7/2023

Abstract

Background

Long-term kidney outcomes of non-dialyzed children with Shiga-toxin Escherichia Coli hemolytic uremic syndrome (STEC-HUS) have been scantily studied. Therefore, we aimed to evaluate kidney outcomes and prognostic markers in these patients.

Methods

Non-dialyzed STEC-HUS patients followed for at least 5 years were included. They were grouped and compared according to kidney status at last visit: complete recovery (CR) or chronic kidney disease (CKD). Predictors of CKD evaluated at diagnosis were sex, age, leukocytes, hematocrit, hemoglobin (Hb), and serum creatinine (sCr). Peak sCr and time of follow-up were also analyzed.

Results

A total of 122 patients (62 female, median age at diagnosis 1.6 years) with a median follow-up of 11.3 years were included. At last visit, 82 (67%) had CR, 36 (30%) had CKD stage 1, and 4 (3%) had stage 2. No patient developed CKD stage 3–5. Median time to CKD was 5 years (IQR 3.1–8.76 years). Of the 122 patients, 18% evolved to CKD in the first 5 years, increasing to 28% at 10 and 33% at 20 years of follow-up. Serum Cr at diagnosis and peak sCr were significantly higher in patients with CKD than in those with CR.

Conclusions

One third of non-dialyzed STEC-HUS patients evolved to CKD after a median time of 5 years. However, CKD may appear even after 15 years of CR. Serum Cr was significantly higher among patients who evolved to CKD. These data reinforce that all non-dialyzed patients should be followed until adulthood.

Graphical abstract

Available only for authorised users

Siegler RL, Milligan MK, Burningham TH, Christofferson RD, Chang SY, Jorde LB (1991) Long-term outcome and prognostic indicators in the hemolytic-uremic syndrome. J Pediatr 118:195–200. https://doi.org/10.1016/s0022-3476(05)80482-2CrossRefPubMed

Spizzirri FD, Rahman RC, Bibiloni N, Ruscasso JD, Amoreo OR (1997) Childhood hemolytic uremic syndrome in Argentina: long-term follow-up and prognostic features. Pediatr Nephrol 11:156–160. https://doi.org/10.1007/s004670050248CrossRefPubMed

Spinale JM, Ruebner RL, Copelovitch L, Kaplan BS (2013) Long-term outcomes of Shiga toxin hemolytic uremic syndrome. Pediatr Nephrol 28:2097–2105. https://doi.org/10.1007/s00467-012-2383-6CrossRefPubMed

Oakes RS, Kirkham JK, Nelson RD, Siegler RL (2008) Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome. Pediatr Nephrol 23:1303–1308. https://doi.org/10.1007/s00467-008-0799CrossRefPubMed

Cobeñas CJ, Alconcher LF, Spizzirri AP, Rahman RC (2007) Long-term follow-up of Argentinean patients with hemolytic uremic syndrome who had not undergone dialysis. Pediatr Nephrol 22:1343–1347. https://doi.org/10.1007/s00467-007-0522-2CrossRefPubMed

Balestracci A, Meni Battaglia L, Toledo I, Martin SM, Puyol I, Beaudoin L, Robledo NL (2021) Diagnostic sensitivity of extended renal and hematologic criteria to define hemolytic uremic syndrome. Arch Argent Pediatr 119:238–244. https://doi.org/10.5546/aap.2021.eng.238CrossRefPubMed

Coccia P, Ramírez F, Suárez A, Alconcher L, Balestracci A et al (2021) Acute peritoneal dialysis, complications and outcomes in 389 children with STEC-HUS: a multicenter experience. Pediatr Nephrol 36:1597–1606. https://doi.org/10.1007/s00467-020-04876-xCrossRefPubMed

Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263. https://doi.org/10.1542/peds.58.2.259CrossRefPubMed

Hogg RJ, Furth S, Lemley KV, Portman R, Schwartz GJ, Coresh J, Balk E, Lau J, Levin A, Kausz AT, Eknoyan G, Levey AS, National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (2003) National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification. Pediatrics 111:1416–1421. https://doi.org/10.1542/peds.111.6.1416CrossRefPubMed

10.

Cubillos CMP, Del Salas P, Zambrano PO (2015) Microalbuminuria in pediatric patients diagnosed with hemolytic uremic syndrome. Rev Chil Pediatr 86:92–96. https://doi.org/10.1016/j.rchipe.2015.04.019CrossRef

11.

Flynn JT, Kaelber DC, Baker-Smith CM, Subcommittee on screening and management of high blood pressure in children et al (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904. https://doi.org/10.1542/peds.2017-3035CrossRefPubMed

12.

KDIGO CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3:1–150. https://www.kisupplements.org/article/S2157-1716(16)30005-3/fulltext

13.

Pundzienė B, Dobilienė D, Čerkauskienė R, Mitkienė R, Medzevičienė A, Darškuvienė E, Jankauskienė A (2015) Long-term follow-up of children with typical hemolytic uremic syndrome. Medicina 51:146–151. https://doi.org/10.1016/j.medici.2015.06.004CrossRefPubMed

14.

Monet-Didailler C, Godron-Dubrasquet A, Madden I, Delmas Y, Llanas B, Harambat J (2019) Long-term outcome of diarrhea-associated hemolytic uremic syndrome is poorly related to markers of kidney injury at 1-year follow-up in a population-based cohort. Pediatr Nephrol 34:657–662. https://doi.org/10.1007/s00467-018-4131-zCrossRefPubMed

15.

Repetto HA (2005) Long-term course and mechanisms of progression of renal disease in hemolytic uremic syndrome. Kidney Int 97:S102–S106. https://doi.org/10.1111/j.1523-1755.2005.09717.xCrossRef

16.

Lou-Meda R, Oakes RS, Gilstrap JN, Williams CG, Siegler RL (2007) Prognostic significance of microalbuminuria in postdiarrheal hemolytic uremic syndrome. Pediatr Nephrol 22:117–120. https://doi.org/10.1007/s00467-006-0283-3CrossRefPubMed

17.

Small G, Watson AR, Evans JH, Gallagher J (1999) Hemolytic uremic syndrome: defining the need for long-term follow-up. Clin Nephrol 52:352–356PubMed

18.

Van Dyck M, Proesmans W (2004) Renoprotection by ACE inhibitors after severe hemolytic uremic syndrome. Pediatr Nephrol 19:688–690. https://doi.org/10.1007/s00467-004-1451-yCrossRefPubMed

19.

Caletti MG, Missoni M, Vezzani C, Grignoli M, Piantanida JJ, Repetto HA, Exeni R, Rasse SM (2011) Effect of diet, enalapril, or losartan in post-diarrheal hemolytic uremic syndrome nephropathy. Pediatr Nephrol 26:1247–1254. https://doi.org/10.1007/s00467-011-1867-0CrossRefPubMed

20.

Caletti MG, Balestracci A, Missoni M, Vezzani C (2013) Additive antiproteinuric effect of enalapril and losartan in children with hemolytic uremic syndrome. Pediatr Nephrol 28:745–750. https://doi.org/10.1007/s00467-012-2374-7CrossRefPubMed

21.

Ardissino G, Daccò V, Testa S, Civitillo CF, Tel F, Possenti I, Belingheri M, Castorina P, Bolsa-Ghiringhelli N, Tedeschi S, Paglialonga F, Salardi S, Consonni D, Zoia E, Salice P, Chidini G (2015) Hemoconcentration: a major risk factor for neurological involvement in hemolytic uremic syndrome. Pediatr Nephrol 30:345–352. https://doi.org/10.1007/s00467-014-2918-0CrossRefPubMed

Title: Long-term kidney outcomes in non-dialyzed children with Shiga-toxin Escherichia coli associated hemolytic uremic syndrome
Authors: Laura F. Alconcher
Lucas I. Lucarelli
Sabrina Bronfen
Publication date: 03-01-2023
Publisher: Springer Berlin Heidelberg
Keywords: Escherichia Coli
Hemolytic Uremic Syndrome
Diarrhea
Albuminuria
Chronic Kidney Disease
Diarrhea
Published in: Pediatric Nephrology / Issue 7/2023
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-022-05851-4

At a glance: The STEP trials

Springer Medicine

Long-term kidney outcomes in non-dialyzed children with Shiga-toxin Escherichia coli associated hemolytic uremic syndrome

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Please log in to get access to this content

Other articles of this Issue 7/2023

Hyperchloremia and association with acute kidney injury in critically ill children

Adverse childhood experiences are associated with vascular changes in adolescents that are risk factors for future cardiovascular disease

Kidney concentrating capacity in children with autosomal recessive polycystic kidney disease is linked to glomerular filtration and hypertension

Failure to thrive in an 8-month-old female: Answers

Three Tesla magnetic resonance imaging detects oxalate osteopathy in patients with primary hyperoxaluria type I

Comparison of axial and coronal axis MRI kidney volume measurement in pediatric congenital solitary kidney