The late histologic findings in diarrhea-associated hemolytic uremic syndrome.
Kidney biopsies were undertaken for persisting proteinuria 3.3 to 7 years (mean 5.4 years) from the onset of diarrhea-associated hemolytic uremic syndrome (D + HUS) in 5 boys and 2 girls (age at presentation mean 3.2 years, range 1.0 to 9.7 years). At 1 year the mean early morning urine protein/creatinine ratio was 100 mg/mmol, and the mean glomerular filtration rate was 65 mL/min/1.73 m2. At 5 years the mean early morning urine protein/creatinine ratio was 81 mg/mmol, and the mean glomerular filtration rate was 73 mL/min/1.73 m2. The biopsy specimens were compared with those of 7 age- and sex-matched children who were investigated for isolated persistent microscopic hematuria but in whom no abnormality was detected. Global glomerulosclerosis was noted in 6 patients with D + HUS, and 2 of these had segmental sclerosing lesions. Tubular atrophy and interstitial scarring were seen in all but 1 patients. The glomeruli in the D + HUS group were significantly larger than in the control group (P < .01). These findings are typically found in kidneys with reduced nephron numbers and are compatible with changes of hyperperfusion and hyperfiltration in surviving nephrons. Long-term follow-up of patients with D + HUS and proteinuria is advisable.
Department of Pathology, Children's Hospital, University of Birmingham, United Kingdom.
N E
NE
Moghal
M A
MA
Ferreira
A J
AJ
Howie
D V
DV
Milford
E
E
Raafat
C M
CM
Taylor
D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications / Q000473:pathology*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000473:pathology*; D006801:Humans; D007223:Infant; D007668:Kidney / Q000473:pathology*; D007678:Kidney Glomerulus / Q000473:pathology; D008297:Male; D011507:Proteinuria / Q000209:etiology / Q000473:pathology; D013997:Time Factors