title: Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome.
abstract: OBJECTIVE
  To determine if interventions during the pre-hemolytic uremic syndrome (HUS) diarrhea phase are associated with maintenance of urine output during HUS.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Eleven pediatric hospitals in the United States and Scotland.
  
  
  METHODS
  Children younger than 18 years with diarrhea-associated HUS (hematocrit level <30% with smear evidence of intravascular erythrocyte destruction), thrombocytopenia (platelet count <150 × 10³/mm³), and impaired renal function (serum creatinine concentration > upper limit of reference range for age).
  
  
  METHODS
  Intravenous fluid was given within the first 4 days of the onset of diarrhea.
  
  
  METHODS
  Presence or absence of oligoanuria (urine output ≤ 0.5 mL/kg/h for >1 day).
  
  
  RESULTS
  The overall oligoanuric rate of the 50 participants was 68%, but was 84% among those who received no intravenous fluids in the first 4 days of illness. The relative risk of oligoanuria when fluids were not given in this interval was 1.6 (95% confidence interval, 1.1-2.4; P = .02). Children with oligoanuric HUS were given less total intravenous fluid (r = -0.32; P = .02) and sodium (r = -0.27; P = .05) in the first 4 days of illness than those without oligoanuria. In multivariable analysis, the most significant covariate was volume infused, but volume and sodium strongly covaried.
  
  
  CONCLUSIONS
  Intravenous volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS.
authors.affiliation: Division of Gastroenterology and Nutrition, Department of Pediatrics, Washington University School of Medicine, 1 Children's Place, St Louis, MO 63110, USA.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Hickey
authors.forename: T James
authors.initials: TJ
authors.lastname: Beattie
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cowieson
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Miyashita
authors.forename: C Frederic
authors.initials: CF
authors.lastname: Strife
authors.forename: Juliana C
authors.initials: JC
authors.lastname: Frem
authors.forename: Johann M
authors.initials: JM
authors.lastname: Peterson
authors.forename: Lavjay
authors.initials: L
authors.lastname: Butani
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Jones
authors.forename: Peter L
authors.initials: PL
authors.lastname: Havens
authors.forename: Hiren P
authors.initials: HP
authors.lastname: Patel
authors.forename: Craig S
authors.initials: CS
authors.lastname: Wong
authors.forename: Sharon P
authors.initials: SP
authors.lastname: Andreoli
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Rothbaum
authors.forename: Anne M
authors.initials: AM
authors.lastname: Beck
authors.forename: Phillip I
authors.initials: PI
authors.lastname: Tarr
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000517:prevention & control; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000628:therapy* / Q000652:urine; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009846:Oliguria / Q000209:etiology* / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome