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Haemolytic-uraemic syndrome: a 10-year follow-up study of 73 patients
Insights
Long-term follow-up of 73 patients with haemolytic-uraemic syndrome reveals that severity of acute illness correlates with late sequelae. Patients with longer oliguria or anuria experienced more significant kidney function decline and hypertension.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Internal Medicine
Background:
- Hemolytic-uremic syndrome (HUS) is a severe condition often affecting children.
- Long-term outcomes and sequelae of HUS require further investigation.
Purpose of the Study:
- To assess the long-term sequelae of hemolytic-uremic syndrome (HUS) 10 years after the acute phase.
- To correlate the severity of the acute illness, based on oliguria/anuria duration, with the development of late complications.
Main Methods:
- A cohort of 73 HUS patients underwent a 10-year follow-up.
- Patients were categorized into three groups based on oliguria/anuria duration (Gianantonio criteria).
- Assessment included blood pressure, glomerular filtration rate (GFR), concentrating capacity, and proteinuria.
Main Results:
- Group 1 (oliguria < 7 days): 4/38 patients had mild hypertension.
- Group 2 (oliguria 7-14 days or anuria < 7 days): 2/29 patients had diminished GFR, reduced concentrating capacity, proteinuria, and mild hypertension; 5/29 had mild proteinuria, one with hypertension.
- Group 3 (oliguria > 14 days or anuria > 7 days): All 6 patients had late sequelae, including need for hemodialysis (2/6) and decreased GFR/concentrating capacity (3/6). One patient had decreased concentrating capacity with normal GFR and no hypertension.
Conclusions:
- The duration of oliguria/anuria during the acute phase of HUS is a significant predictor of long-term renal sequelae.
- Patients with more severe acute illness are at higher risk for decreased GFR, impaired concentrating ability, and hypertension.
- Close monitoring and management of renal function are crucial for children recovering from HUS, especially those with initial signs of GFR reduction.
Abstract:
Long-term follow-up is presented of 73 patients suffering from the haemolytic-uraemic syndrome 10 years after the acute initial illness. The patients were subdivided into three groups, according to the criteria proposed by Gianantonio and based on the duration of oliguria and/or anuria. Four out of 38 patients belonging to the first group (oliguria for less than 7 days) had a slightly increased blood pressure as the only sequela. Two patients out of group two (n = 29, oliguria for 7-14 days or anuria for less than 7 days) had a diminished GFR and a reduced concentrating capacity, some proteinuria, and mild hypertension. Five other patients had slight proteinuria (less than 500 mg/24 h) and one of them a mild hypertension. All six patients belonging to the third group (oliguria for more than 14 days or anuria for more than 7 days) had late sequelae: two started haemodialysis more than 10 years after the initial phase; three have a decreased GFR and concentrating capacity. The unique remaining patient with a normal GFR without hypertension has a decreased concentrating capacity. The importance of careful treatment in children with a decreased GFR 2 years after the initial phase is stressed.