Intermediate Follow-up of Pediatric Patients With Hemolytic Uremic Syndrome During the 2011 Outbreak Caused by E. coli O104:H4.
In 2011 Escherichia coli O104:H4 caused an outbreak with >800 cases of hemolytic uremic syndrome (HUS) in Germany, including 90 children. Data on the intermediate outcome in children after HUS due to E. coli O104:H4 have been lacking.
Follow-up data were gathered retrospectively from the medical records of patients who had been included in the German Pediatric HUS Registry during the 2011 outbreak.
Seventy-two of the 89 (81%) patients were included after a median follow-up of 3.0 (0.9-4.7) years. Hypertension and proteinuria were present in 19% and 28% of these patients, respectively. Of 4 patients with chronic kidney disease (CKD) > stage 2 at short-term follow-up, 1 had a normalized estimated glomerular filtration rate, and 3 (4%) had persistent CKD > stage 2. In 1 of these patients, CKD improved from stage 4 to 3; 1 who had CKD stage 5 at presentation received kidney transplantation; and 1 patient required further hemodialysis during follow-up. One patient (1.4%) still had major neurological symptoms at the latest follow-up. Dialysis during the acute phase (P = .01), dialysis duration (P = .01), and the duration of oligo-/anuria (P = .005) were associated with the development of renal sequelae. Patients treated with eculizumab (n = 11) and/or plasmapheresis (n = 13) during the acute phase of HUS had comparable outcomes.
The overall outcome of pediatric patients after HUS due to E. coli O104:H4 was equivalent to previous reports on HUS due to other types of Shiga toxin-producing E. coli (STEC). Regular follow-up visits in patients are recommended after STEC-HUS.
University Children's Hospital, University Medical Center Hamburg-Eppendorf.
Sebastian
S
Loos
University Children's Hospital, University Medical Center Hamburg-Eppendorf.
Wiebke
W
Aulbert
Department of Pediatric Nephrology, University Children's Hospital Bonn.
Bernd
B
Hoppe
Departement of Pediatric Nephrology, Medical School Hannover.
Thurid
T
Ahlenstiel-Grunow
Department of General Pediatrics, Pediatric Nephrology, University Children's Hospital Muenster.
Birgitta
B
Kranz
Department of Pediatrics, University Hospital Essen.
Charlotte
C
Wahl
Department of Pediatrics, University Hospital Rostock.
Hagen
H
Staude
Department of Pediatrics, University Hospital Schleswig-Holstein, Lu¨beck.
Alexander
A
Humberg
Department of Pediatrics, University Hospital Erlangen.
Kerstin
K
Benz
Department of Pediatrics, University Hospital Schleswig-Holstein, Kiel.
Martin
M
Krause
Department of Pediatrics, University Hospital Freiburg.
Martin
M
Pohl
Department of Pediatrics, Department II of Internal Medicine, Center for Molecular Medicine, Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases (CECAD), and Systems Biology of Ageing Cologne (Sybacol), University of Cologne.
Max C
MC
Liebau
University Children's Hospital, University Medical Center Hamburg-Eppendorf.
Raphael
R
Schild
University Children's Hospital, University Medical Center Hamburg-Eppendorf.
Johanna
J
Lemke
Department of Pediatrics, University Hospital Ulm.
Ortraud
O
Beringer
Department of Pediatrics, Charité Berlin, and.
Dominik
D
Müller
Department of Pediatrics, University Hospital Schleswig-Holstein, Lu¨beck.
Christoph
C
Härtel
Department of Pediatrics, University Hospital Rostock.
Marianne
M
Wigger
Department of Pediatrics, University Hospital Essen.
Udo
U
Vester
Department of General Pediatrics, Pediatric Nephrology, University Children's Hospital Muenster.
Martin
M
Konrad
Departement of Pediatric Nephrology, Medical School Hannover.
Dieter
D
Haffner
Departement of Pediatric Nephrology, Medical School Hannover.
Lars
L
Pape
University Children's Hospital, University Medical Center Hamburg-Eppendorf.
Jun
J
Oh
University Children's Hospital, University Medical Center Hamburg-Eppendorf.|Department of Pediatrics, AK Hamburg Nord, Asklepios Medical School, Germany.
Markus J
MJ
Kemper
D000293:Adolescent; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004927:Escherichia coli Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D000069981:Escherichia coli O104 / Q000302:isolation & purification*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006463:Hemolytic-Uremic Syndrome / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D016030:Kidney Transplantation; D008297:Male; D008499:Medical Records; D011379:Prognosis; D011507:Proteinuria / Q000453:epidemiology / Q000209:etiology; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult
D061067:Antibodies, Monoclonal, Humanized; C481642:eculizumab
Shiga toxin–producing Escherichia coli; eculizumab.; enterohemorrhagic Escherichia coli; follow-up; hemolytic uremic syndrome