Related Experiment Videos
Hemolytic uremic syndrome: defining the need for long-term follow-up
G Small1, A R Watson, J H Evans
1Children and Young People's Renal Unit, City Hospital, NHS Trust, Nottingham, UK.
Insights
Most children recover normal kidney function after diarrhea-associated hemolytic uremic syndrome (HUS). Long-term follow-up for HUS patients is likely only needed for those with impaired renal function or specific risk factors at one year.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Infectious Disease Epidemiology
Background:
- Diarrhea-associated hemolytic uremic syndrome (D+ HUS) is a leading cause of acute kidney injury in children.
- Progressive renal insufficiency is a known complication in some HUS survivors.
- The necessity of long-term follow-up for all HUS patients remains unclear.
Purpose of the Study:
- To evaluate the long-term renal outcomes in children following D+ HUS.
- To identify predictors of chronic renal impairment after HUS.
- To determine criteria for necessary long-term patient follow-up.
Main Methods:
- Retrospective review of 114 pediatric D+ HUS cases from 1986-1996.
- Annual clinical assessments including blood pressure and urinalysis for proteinuria.
- Glomerular filtration rate (GFR) assessment at 1 and 5 years post-illness using 51Cr EDTA slope clearance.
Main Results:
- At 1 year, 72% of patients had normal renal function (GFR ≥80 ml/min/1.73 m2), 22% had mild chronic renal failure (CRF), and 5% had moderate to severe CRF.
- Of those with normal GFR at 1 year, 3 out of 28 deteriorated into mild CRF by year 5.
- A negative correlation was observed between dialysis duration and 1-year GFR (r=-0.453, p<0.01).
Conclusions:
- Renal function at 1 year post-HUS is not reliably predictable from the initial illness severity and requires formal assessment.
- Most children maintain stable, normal renal function between 1 and 5 years after HUS.
- Long-term follow-up may be reserved for patients presenting with proteinuria, hypertension, abnormal renal ultrasound, or impaired GFR at the 1-year assessment.
Background:
Diarrhea-associated (D+) hemolytic uremic syndrome (HUS) is a common cause of acute renal failure in children. Progressive renal insufficiency has been documented on prolonged follow-up of selected patients. However, it is uncertain whether all children recovering from varying degrees of HUS require long-term follow-up.
Patients And Methods:
We reviewed the outcome of 114 patients with D+ HUS presenting to a regional pediatric unit between January 1986 and December 1996. Yearly clinical review post illness included measurement of blood pressure and urinalysis for proteinuria with planned GFR assessments by 51Cr EDTA slope clearance at 1 and 5 years.
Results:
Treatment of the HUS was conservative in 27%, by peritoneal dialysis in 62%, hemodialysis in 4% and both peritoneal and hemodialysis in 7%. Ninety-two patients were assessed at 1 year - of these, 1 remained on chronic peritoneal dialysis, 5 (5%) had moderate to severe chronic renal failure (CRF) (GFR 25 - 50 ml/min/1.73 m2), 20 (22%) had mild CRF (GFR 50-80) and 66 (72%) had normal renal function (> or =80 ml/min/1.73 m2). Forty patients have had GFRs performed at 1 and 5 years. Of the 28 patients with a normal GFR at 1 year, 3 deteriorated into mild CRF at 5 years. One patient has a single kidney and one had significant proteinuria at 1 year, factors which would have led to long-term follow-up. There was a negative correlation between number of days of dialysis and GFR at 1 year with a Pearson's correlation coefficient of -0.453 (p<0.01).
Conclusion:
We conclude that renal function at I year following HUS cannot be predicted with any certainty from the initial illness and should be formally assessed. However, renal function was within normal limits and remained stable between 1 and 5 years following HUS in most children. The results suggest that longer-term follow-up can probably be restricted to those with proteinuria, hypertension, abnormal ultrasound and/or impaired GFR at 1 year.