Albuminuria and estimated GFR 5 years after Escherichia coli O157 hemolytic uremic syndrome: an update.
BACKGROUND
Knowledge of the long-term prognosis of patients with diarrhea-associated hemolytic uremic syndrome (HUS) is important for patient counseling and follow-up. Estimates in the literature are highly variable, and previous studies did not use a healthy control group to establish outcomes attributable to HUS.


METHODS
Prospective cohort study.


METHODS
19 children who recovered from HUS after contamination of their municipal water supply by Escherichia coli O157:H7.


METHODS
Outcomes of children who recovered from HUS were compared with a control group of 64 children who were healthy at the time of the outbreak. Both groups were similar in their demographics and follow-up testing.


METHODS
Proteinuria, blood pressure, glomerular filtration rate (GFR) estimated by using serum creatinine or cystatin C level, and biochemical measures 5 years after the outbreak.


RESULTS
More children who recovered from HUS showed microalbuminuria than controls (20% versus 3%; relative risk, 6.0; 95% confidence interval, 1.1 to 32.8). There were no differences between groups in blood pressure or GFR when estimated by using serum creatinine level. GFR estimated by using cystatin C level was lower after HUS compared with controls (100 versus 110 mL/min/1.73 m(2); P = 0.02), but no child had a GFR less than 80 mL/min/1.73 m(2). Other results, including fasting glucose, albumin, and C-reactive protein levels, did not differ between groups.


CONCLUSIONS
Although the homogenous nature of this outbreak is a strength, long-term results may generalize less well to patients with other strains of toxigenic E coli or in other settings.


CONCLUSIONS
The prognosis of patients with HUS in this cohort was better than in other studies. Ongoing follow-up will clarify the clinical relevance of microalbuminuria and mild decreases in GFR 5 years after HUS recovery.
Garg
Amit X
AX
Division of Nephrology, University of Western Ontario, London, Canada. amit.garg@lhsc.on.ca
Salvadori
Marina
M
Okell
Justin M
JM
Thiessen-Philbrook
Heather R
HR
Suri
Rita S
RS
Filler
Guido
G
Moist
Louise
L
Matsell
Douglas
D
Clark
William F
WF
D000419:Albuminuria / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D019453:Escherichia coli O157; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006463:Hemolytic-Uremic Syndrome / Q000150:complications* / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D008297:Male; D009864:Ontario; D011379:Prognosis; D011446:Prospective Studies; D014871:Water Microbiology; D014881:Water Supply