Hemolytic uremic syndrome: late renal injury and changing incidence-a single centre experience in Canada

Area of Science:

• Pediatric Nephrology
• Infectious Disease Epidemiology
• Public Health

Background:

• Diarrhea-associated hemolytic uremic syndrome (D(+) HUS) is a serious complication in children.
• Long-term renal sequelae following D(+) HUS require further investigation.
• Understanding incidence trends is crucial for public health interventions.

Purpose of the Study:

• To analyze trends in pediatric D(+) HUS incidence over a 35-year period.
• To document the occurrence and nature of long-term renal sequelae in D(+) HUS survivors.
• To identify predictors of severe renal complications.

Main Methods:

• Retrospective cohort study of pediatric D(+) HUS cases admitted between 1976 and 2010.
• Longitudinal follow-up, including recontacting patients admitted before 2000.
• Statistical analysis to assess incidence trends and identify predictors of renal sequelae.

Main Results:

• Yearly incidence of D(+) HUS peaked in the late 20th century, returning to 1977 levels by 2003.
• Twelve patients (3.6%) died; 19 (5.6%) developed end-stage renal failure.
• Need for dialysis was the strongest predictor of severe renal complications (100% of severe cases).
• Overall sequelae rate was 18.6% at 1 year and 35.3% at 10 years post-HUS, including microalbuminuria.

Conclusions:

• Children with D(+) HUS require long-term monitoring (≥5 years), including microalbuminuria testing, particularly if dialysis was necessary.
• The decline in D(+) HUS incidence may be linked to improved public health education and food safety.
• Further research is needed to elucidate the exact causes for the declining incidence.