title: Hemoconcentration: a major risk factor for neurological involvement in hemolytic uremic syndrome.
abstract: BACKGROUND
  Shigatoxin-associated hemolytic uremic syndrome (STEC-HUS) is a common thrombotic microangiopathy (TMA) in which central nervous system (CNS) involvement is responsible for the majority of deaths and for severe long-term sequelae. We have analyzed the role of hemoconcentration in disease severity.
  
  
  METHODS
  This was a retrospective review of the records and laboratory data at presentation of all patients with STEC-HUS cases (n = 61) over a 10-year period. The patients were grouped into three severity classes: group A, comprising patients who did not require dialysis; group B, patients who were dialyzed without CNS involvement; group C, patients with CNS involvement.
  
  
  RESULTS
  Patients with CNS involvement (group C) had a higher mean hemoglobin level (11.2 ± 2.3 g/dL) than those of group A or B ( 9.4 ± 2.1 and 7.5 ± 1.9 g/dL, respectively; p < 0.0001). We also observed that the higher the initial hemoglobin level, the more severe the long-term renal damage (p < 0.007).
  
  
  CONCLUSIONS
  In patients with STEC-HUS, hemoconcentration and hypovolemia may be responsible for more severe ischemic organ damage (both short and long term) at disease onset, and these signs should be regarded as risk factors for CNS damage and for more severe TMA. Therefore, we recommend that hydration status should be actively monitored in HUS patients and that dehydration, when diagnosed, should be promptly corrected.
authors.affiliation: Center for HUS Control, Prevention and Management, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy, ardissino@italkid.org.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ardissino
authors.forename: Valeria
authors.initials: V
authors.lastname: Daccò
authors.forename: Sara
authors.initials: S
authors.lastname: Testa
authors.forename: Cristina Felice
authors.initials: CF
authors.lastname: Civitillo
authors.forename: Francesca
authors.initials: F
authors.lastname: Tel
authors.forename: Ilaria
authors.initials: I
authors.lastname: Possenti
authors.forename: Mirco
authors.initials: M
authors.lastname: Belingheri
authors.forename: Pierangela
authors.initials: P
authors.lastname: Castorina
authors.forename: Nicolò
authors.initials: N
authors.lastname: Bolsa-Ghiringhelli
authors.forename: Silvana
authors.initials: S
authors.lastname: Tedeschi
authors.forename: Fabio
authors.initials: F
authors.lastname: Paglialonga
authors.forename: Stefania
authors.initials: S
authors.lastname: Salardi
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.forename: Elena
authors.initials: E
authors.lastname: Zoia
authors.forename: Patrizia
authors.initials: P
authors.lastname: Salice
authors.forename: Giovanna
authors.initials: G
authors.lastname: Chidini
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006400:Hematocrit; D006463:Hemolytic-Uremic Syndrome / Q000097:blood* / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors