title: Clinical characteristics and long-term outcome of diarrhea-associated hemolytic uremic syndrome: a single center experience.
abstract: OBJECTIVE
  To clarify the clinical characteristics and long-term outcomes of patients with diarrhea-associated hemolytic uremic syndrome (D + HUS) with a particular focus on time course.
  
  
  METHODS
  We retrospectively analyzed the medical records of 61 patients with D + HUS who were admitted to Kobe University Hospital between 1995 and 2015. The onset of D + HUS was defined as day 1 of diarrhea.
  
  
  RESULTS
  The age of onset was 4.1 (1.5-13.4) years, and the period between onset and diagnosis of D + HUS was 5 (3-18) days. The platelet count was lowest on day 7 (4-24), and the lactase dehydrogenase level was maximal on day 8 (4-25). Twenty-three patients required dialysis for 13 (2-37) days, starting at day 5-9. Seventeen patients showed central nervous system (CNS) symptoms at day 4-18. They were followed up for 3.7 (0-18.4) years. At the final follow-up, estimated glomerular filtration rate was 113.7 (57.9-159.9) ml/min/1.73 m2with five patients having chronic kidney disease. Three patients developed CNS sequelae. The time to diagnosis was significantly shorter in the group of patients receiving dialysis than without dialysis (p = 0.018) and in the group with CNS complications than without (p = 0.013).
  
  
  CONCLUSIONS
  CNS complications were often apparent after blood examination results improved. Moreover, a shorter period between the onset of diarrhea and a diagnosis of D + HUS indicated a more severe clinical course or long-term sequelae, and it should be considered as a risk factor for poor prognosis.
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo, Kobe, 6500017, Japan. nincho@med.kobe-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ninchoji
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo, Kobe, 6500017, Japan.
authors.forename: Kandai
authors.initials: K
authors.lastname: Nozu
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo, Kobe, 6500017, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Nakanishi
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo, Kobe, 6500017, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Horinouchi
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo, Kobe, 6500017, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Fujimura
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo, Kobe, 6500017, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Yamamura
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo, Kobe, 6500017, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Minamikawa
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo, Kobe, 6500017, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Ishimori
authors.affiliation: Department of Pediatrics, Wakayama Medical University, Wakayama, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakanishi
authors.affiliation: Clinical Research Center, Wakayama Medical University, Wakayama, Japan.
authors.forename: Norishige
authors.initials: N
authors.lastname: Yoshikawa
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo, Kobe, 6500017, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Morioka
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo, Kobe, 6500017, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kaito
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo, Kobe, 6500017, Japan.
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Iijima
mesh_terms: D000293:Adolescent; D002493:Central Nervous System Diseases / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications* / Q000175:diagnosis; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007564:Japan; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008499:Medical Records; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors
keywords: Central nervous system complication; Dialysis; Hemolytic uremic syndrome; Kidney dysfunction