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

Author

Angela Caringella, Elio Salvaggio, Laura De Petris, Leopoldo Peratoner, Maurizio Gaido, Lucilla Ravà, Alberto Edefonti, Alfredo Caprioli, Rosanna Coppo, Alfonso Ferretti, Giovanni Montini, Giovambattista Capasso, Gianfranco Rizzoni, Rosa Penza, Salvatore Li Volti, Alessandra Gianviti, Carmen Setzu, Gianluigi Ardissino, Nunzia Miglietti, Salvatore Maffei, Carmine Pecoraro, Alberto Eugenio Tozzi, Graziella Zacchello, Ilse Ratsche, Alberto Bettinelli, Silvio Maringhini, Marco Pennesi, Francesco Perfumo, Ivana Pela, Giuliana Lama, Tommaso De Palo, Gianviti, A, Tozzi, Ae, DE PETRIS, L, Caprioli, A, Rava, L, Edefonti, A, Ardissino, G, Montini, G, Zacchello, G, Ferretti, A, Pecoraro, C, DE PALO, T, Caringella, A, Gaido, M, Coppo, R, Perfumo, F, Miglietti, N, Ratsche, I, Penza, R, Capasso, Giovambattista, Maringhini, S, LI VOLTI, S, Setzu, C, Pennesi, M, Bettinelli, A, Peratoner, L, Pela, I, Salvaggio, E, Lama, G, Maffei, S, and Rizzoni, G.

Subjects
Nephrology, Diarrhea, Male, medicine.medical_specialty, Atypical hemolytic uremic syndrome, Adolescent, medicine.medical_treatment, Gastroenterology, Shiga Toxin, Cohort Studies, Leukocyte Count, fluids and secretions, Shiga toxin-producing Escherichia coli, Central Nervous System Diseases, Risk Factors, Internal medicine, medicine, Humans, Risk factor, Age of Onset, Child, Escherichia coli Infections, Proportional Hazards Models, Prognostic factor, business.industry, Proportional hazards model, Infant, Classification, medicine.disease, Prognosis, Long-term outcome, Survival Analysis, Hemolytic urenic syndrome, Treatment Outcome, Italy, Child, Preschool, Pediatrics, Perinatology and Child Health, Immunology, Hemolytic-Uremic Syndrome, Plasmapheresis, Female, medicine.symptom, Age of onset, business, Kidney disease
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.

Published
2003

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