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.
Gianviti
Alessandra
A
Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital and Institute for Scientific Research, Rome, Italy. gianviti@opbg.net
Tozzi
Alberto E
AE
De Petris
Laura
L
Caprioli
Alfredo
A
Ravà
Lucilla
L
Edefonti
Alberto
A
Ardissino
Gianluigi
G
Montini
Giovanni
G
Zacchello
Graziella
G
Ferretti
Alfonso
A
Pecoraro
Carmine
C
De Palo
Tommaso
T
Caringella
Angela
A
Gaido
Maurizio
M
Coppo
Rosanna
R
Perfumo
Francesco
F
Miglietti
Nunzia
N
Ratsche
Ilse
I
Penza
Rosa
R
Capasso
Giovambattista
G
Maringhini
Silvio
S
Li Volti
Salvatore
S
Setzu
Carmen
C
Pennesi
Marco
M
Bettinelli
Alberto
A
Peratoner
Leopoldo
L
Pela
Ivana
I
Salvaggio
Elio
E
Lama
Giuliana
G
Maffei
Salvatore
S
Rizzoni
Gianfranco
G
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