title: Hypertension and mild chronic kidney disease persist following severe haemolytic uraemic syndrome caused by Shiga toxin-producing Escherichia coli O104:H4 in adults.
abstract: BACKGROUND
  Shiga toxin-producing, enteroaggregative Escherichia coli was responsible for the 2011 outbreak of haemolytic uraemic syndrome (HUS). The present single-centre, observational study describes the 1-year course of the disease with an emphasis on kidney function. Outcome data after 1 year are associated with treatment and patient characteristics at onset of HUS.
  
  
  METHODS
  Patients were treated according to a standardized approach of supportive care, including a limited number of plasmapheresis. On top of this treatment, patients with severe HUS (n = 35) received eculizumab, a humanized anti-C5 monoclonal antibody inhibiting terminal complement activation. The per-protocol decision--to start or omit an extended therapy with eculizumab accompanied by azithromycin--separated the patients into two groups and marked Day 0 of the prospective study. Standardized visits assessed the patients' well-being, kidney function, neurological symptoms, haematological changes and blood pressure.
  
  
  RESULTS
  Fifty-six patients were regularly seen during the follow-up. All patients had survived without end-stage renal disease. Young(er) age alleviated restoring kidney function after acute kidney injury even in severe HUS. After 1 year, kidney function was affected with proteinuria [26.7%; 95% confidence interval (CI) 13.8-39.6], increased serum creatinine (4.4%, CI 0.0-10.4), increased cystatin C (46.7%, CI 32.1-61.3) and reduced (<90 mL/min) estimated glomerular filtration rate (46.7%, CI 32.1-61.3). Nine of the 36 patients without previous hypertension developed de novo hypertension (25%, CI 10.9-39.1). All these patients had severe HUS.
  
  
  CONCLUSIONS
  Although shiga toxin-producing Escherichia coli (STEC)-HUS induced by O104:H4 was a life-threatening acute disease, follow-up showed a good recovery of organ function in all patients. Whereas kidney function recovered even after longer duration of dialysis, chronic hypertension developed after severe HUS with neurological symptoms and could not be prevented by the extended therapy.
authors.affiliation: Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.
authors.forename: Inge
authors.initials: I
authors.lastname: Derad
authors.affiliation: Institute for Medical Microbiology, University of Lübeck, Lübeck, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Obermann
authors.affiliation: Department of Epidemiology, University of Lübeck, Lübeck, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Katalinic
authors.affiliation: Department of Epidemiology, University of Lübeck, Lübeck, Germany.
authors.forename: Nora
authors.initials: N
authors.lastname: Eisemann
authors.affiliation: Institute for Medical Microbiology, University of Lübeck, Lübeck, Germany.
authors.forename: Johannes K-M
authors.initials: JK
authors.lastname: Knobloch
authors.affiliation: Department of Internal Medicine II, University of Lübeck, Lübeck, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Sayk
authors.affiliation: Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wellhöner
authors.affiliation: Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Lehnert
authors.affiliation: Institute for Medical Microbiology, University of Lübeck, Lübeck, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Solbach
authors.affiliation: Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Süfke
authors.affiliation: Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Steinhoff
authors.affiliation: Department of Internal Medicine I, University of Lübeck, Lübeck, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Nitschke
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D051056:Complement Inactivating Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D054324:Enterohemorrhagic Escherichia coli; D004927:Escherichia coli Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006463:Hemolytic-Uremic Syndrome / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D006973:Hypertension / Q000382:microbiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000382:microbiology* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D061067:Antibodies, Monoclonal, Humanized; D051056:Complement Inactivating Agents; D017963:Azithromycin; C481642:eculizumab
keywords: HUS; STEC O104:H4; chronic kidney disease; epidemiology and outcome; hypertension; kidney failure; proteinuria