Risk factors for poor renal prognosis in children with hemolytic uremic syndrome.
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.
Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital and Institute for Scientific Research, Rome, Italy. gianviti@opbg.net
Alessandra
A
Gianviti
Alberto E
AE
Tozzi
Laura
L
De Petris
Alfredo
A
Caprioli
Lucilla
L
Ravà
Alberto
A
Edefonti
Gianluigi
G
Ardissino
Giovanni
G
Montini
Graziella
G
Zacchello
Alfonso
A
Ferretti
Carmine
C
Pecoraro
Tommaso
T
De Palo
Angela
A
Caringella
Maurizio
M
Gaido
Rosanna
R
Coppo
Francesco
F
Perfumo
Nunzia
N
Miglietti
Ilse
I
Ratsche
Rosa
R
Penza
Giovambattista
G
Capasso
Silvio
S
Maringhini
Salvatore
S
Li Volti
Carmen
C
Setzu
Marco
M
Pennesi
Alberto
A
Bettinelli
Leopoldo
L
Peratoner
Ivana
I
Pela
Elio
E
Salvaggio
Giuliana
G
Lama
Salvatore
S
Maffei
Gianfranco
G
Rizzoni
D000293:Adolescent; D017668:Age of Onset; D002493:Central Nervous System Diseases / Q000150:complications; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology; D004927:Escherichia coli Infections / Q000150:complications / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D007958:Leukocyte Count; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D022621:Shiga Toxin / Q000378:metabolism; D016019:Survival Analysis; D016896:Treatment Outcome
D022621:Shiga Toxin