Duration of oliguria and anuria as predictors of chronic renal-related sequelae in post-diarrheal hemolytic uremic syndrome.
Prior long-term retrospective studies have described renal sequelae in 25-50% of postdiarrheal hemolytic uremic syndrome (HUS) survivors, but the ability to predict the likelihood of chronic renal-related sequelae at the time of hospital discharge is limited. We surveyed 357 children in our HUS registry who survived an acute episode of post diarrheal HUS (D+HUS) and were without end-stage renal disease (ESRD) at the time of hospital discharge. Of the 357 patients surveyed, 159 had at least 1 year (mean 8.75 years) of follow-up. Of these, 90 individuals were identified as having had at least 1 day of oliguria, with 69 individuals having had at least 1 day of anuria. The incidences of renal-related sequelae [proteinuria, low glomerular filtration rate (GFR), and hypertension] were determined among experimental groups based on oliguria and anuria duration. One or more sequelae (e.g. proteinuria, low GFR, hypertension) was seen in 25 (36.2%) of those who had no recorded oliguria and 34 (37.8%) of those with no recorded anuria. The prevalence of chronic sequelae increased markedly in those with more than 5 days of anuria or 10 days of oliguria, with anuria being a better predictor than oliguria of most related sequelae. A particularly high incidence of hypertension was seen in patients with > 10 days of anuria (55.6%) in comparison with those with no anuria (8.9%) [odds ratio (OR) 12.8; 95% confidence interval (CI) 2.9-57.5]. Patients with > 10 days of anuria were also at substantially increased risk for low GFR and proteinuria (OR 35.2; 95% CI 5.1-240.5). These findings may help identify children who need periodic and extended follow-up after hospital discharge.
Oakes
Robert S
RS
Division of Nephrology and Hypertension, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
Kirkham
Justin K
JK
Kirkhamm
Justin K
JK
Nelson
Raoul D
RD
Siegler
Richard L
RL
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D001002:Anuria / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004927:Escherichia coli Infections / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009846:Oliguria / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D054323:Shiga-Toxigenic Escherichia coli