Endothelial dysfunction during long-term follow-up in children with STEC hemolytic-uremic syndrome.
Shiga-toxin-producing Escherichia coli (STEC)-associated hemolytic-uremic syndrome (HUS) is a major cause of acute kidney injury (AKI), especially in children. Its long-term outcome with respect to endothelial damage remains largely elusive.



This was a cross-sectional study in 26 children who had suffered from STEC-HUS in the past and achieved a complete recovery of renal function (eGFR >90 ml/min/1.73 m2). Skin microcirculation after local heating was assessed by laser Doppler fluximetry, carotid-femoral pulse wave velocity (PWV), carotid intima media thickness (cIMT), 24-h ambulatory blood pressure, and angiopoietin (Ang) 1 and 2 serum levels after a median follow-up period of 6.1 years. The results were compared to those of healthy controls.



All patients were normotensive, mean eGFR was 102 (range 91-154) ml/min/1.73 m2, and 13 of the 26 patients showed albuminuria. Endothelial dysfunction was present in 13 patients, and the mean serum Ang2/Ang1 ratio was increased compared to healthy children (each p < 0.05). In contrast, mean values for PWV and cIMT in the patients did not differ from those of the controls. Endothelial dysfunction was significantly associated with younger age at STEC-HUS manifestation, time after HUS, and presence of albuminuria.



The results of this study highlight the need for long-term follow-up of STEC-HUS patients even after complete recovery of eGFR and lack of hypertension with respect to microvascular damage.
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. kreuzer.martin@mh-hannover.de.
Martin
M
Kreuzer
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
Laura
L
Sollmann
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
Stephan
S
Ruben
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
Maren
M
Leifheit-Nestler
University Children's Hospital, University of Rostock, Rostock, Germany.
Dagmar-Christiane
DC
Fischer
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
Lars
L
Pape
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
Dieter
D
Haffner
D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000473:pathology; D000293:Adolescent; D000367:Age Factors; D000419:Albuminuria / Q000097:blood; D042683:Angiopoietin-1 / Q000097:blood; D042702:Angiopoietin-2 / Q000097:blood; D018660:Blood Pressure Monitoring, Ambulatory; D059168:Carotid Intima-Media Thickness; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000473:pathology*; D004927:Escherichia coli Infections / Q000097:blood / Q000382:microbiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D007223:Infant; D008297:Male; D055806:Microvessels / Q000473:pathology*; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification*; D012867:Skin / Q000098:blood supply; D013997:Time Factors
C467630:ANGPT1 protein, human; C586513:ANGPT2 protein, human; D042683:Angiopoietin-1; D042702:Angiopoietin-2
Arterial stiffness; Endothelial dysfunction; Late-time renal sequelae; STEC hemolytic uremic syndrome; Skin microcirculation