title: Blood urea nitrogen to serum creatinine ratio is an accurate predictor of outcome in diarrhea-associated hemolytic uremic syndrome, a preliminary study.
abstract: Diarrhea-associated hemolytic uremic syndrome (D+HUS) is a common thrombotic microangiopathy during childhood and early identification of parameters predicting poor outcome could enable timely intervention. This study aims to establish the accuracy of BUN-to-serum creatinine ratio at admission, in addition to other parameters in predicting the clinical course and outcome. Records were searched for children between 1 January 2008 and 1 January 2015 admitted with D+HUS. A complicated course was defined as developing one or more of the following: neurological dysfunction, pancreatitis, cardiac or pulmonary involvement, hemodynamic instability, and hematologic complications while poor outcome was defined by death or development of chronic kidney disease. Thirty-four children were included from which 11 with a complicated disease course/poor outcome. Risk of a complicated course/poor outcome was strongly associated with oliguria (p = 0.000006) and hypertension (p = 0.00003) at presentation. In addition, higher serum creatinine (p = 0.000006) and sLDH (p = 0.02) with lower BUN-to-serum creatinine ratio (p = 0.000007) were significantly associated with development of complications. A BUN-to-sCreatinine ratio ≤40 at admission was a sensitive and highly specific predictor of a complicated disease course/poor outcome.
  
  
  CONCLUSIONS
  A BUN-to-serum Creatinine ratio can accurately identify children with D+HUS at risk for a complicated course and poor outcome. What is Known: • Oliguria is a predictor of poor long-term outcome in D+HUS What is New: • BUN-to-serum Creatinine ratio at admission is an entirely novel and accurate predictor of poor outcome and complicated clinical outcome in D+HUS • Early detection of the high risk group in D+HUS enabling early treatment and adequate monitoring.
authors.affiliation: Department of Pediatrics, Pediatric Nephrology, Ghent University Hospital, Gent, Belgium. keenswijkwerner@yahoo.com.
authors.forename: Werner
authors.identifier: http://orcid.org/0000-0001-5576-169X
authors.initials: W
authors.lastname: Keenswijk
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Ghent University Hospital, Gent, Belgium.
authors.forename: Jill
authors.initials: J
authors.lastname: Vanmassenhove
authors.affiliation: Department of Pediatrics, Pediatric Nephrology, Ghent University Hospital, Gent, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Raes
authors.affiliation: Department of Pediatric Intensive Care, Ghent University Hospital, Gent, Belgium.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Dhont
authors.affiliation: Department of Pediatrics, Pediatric Nephrology, Ghent University Hospital, Gent, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Vande Walle
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000032:analysis* / Q000097:blood*; D003967:Diarrhea / Q000150:complications*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000097:blood* / Q000150:complications / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: BUN-to-sCreatinine ratio; Complicated course; Hemolytic uremic syndrome; Poor outcome; Shigatoxin; Thrombothic micro-angiopathy (TMA)