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Postdiarrheal hemolytic uremic syndrome in Egyptian children: An 11-year single-center experience
Riham Eid1, Ashraf Bakr1, Atef Elmougy1
1Pediatric Nephrology Unit, Mansoura University Children's Hospital, Mansoura, Egypt.
Insights
This study reveals that postdiarrheal hemolytic-uremic syndrome (D+HUS) is increasing in Egypt, with factors like anuria duration and neurological involvement predicting poor outcomes in children with acute kidney injury (AKI).
Area of Science:
- Pediatrics
- Nephrology
- Epidemiology
Background:
- Hemolytic-uremic syndrome (HUS), particularly the postdiarrheal (D+HUS) form, is a major cause of childhood acute kidney injury (AKI) globally.
- Limited epidemiological data exist for D+HUS in developing nations, necessitating regional characterization.
Purpose of the Study:
- To characterize the epidemiology, clinical presentation, management, and outcomes of D+HUS in Egyptian children.
- To identify predictors of unfavorable outcomes in pediatric D+HUS cases.
Main Methods:
- Retrospective analysis of 132 children diagnosed with D+HUS admitted to a tertiary pediatric hospital in Egypt between 2007 and 2017.
- Inclusion of epidemiological, clinical, laboratory data, management details, and patient outcomes.
Main Results:
- The incidence of D+HUS showed a yearly increase, peaking in 2017, with a seasonal peak in spring.
- Bloody diarrhea was a common prodrome (83%), and edema/decreased urine output were frequent presentations.
- Factors associated with poor outcomes included prolonged anuria, short interval to AKI, high leukocyte count, low platelet count, elevated lactate dehydrogenase (LDH), and neurological involvement.
Conclusions:
- This is the first detailed report on D+HUS epidemiology in Egyptian children, indicating a rising incidence.
- Increased disease awareness and suboptimal public health measures contribute to the rising incidence.
- Anuria duration, leukocyte count, and neurological involvement are significant predictors of poor outcomes, with LDH serving as a severity marker.
Abstract:
Hemolytic-uremic syndrome (HUS) is a leading cause of childhood acute kidney injury (AKI) worldwide, with its postdiarrheal (D+HUS) form being the most common. Scarce data are available regarding D+HUS epidemiology from developing countries. This study aims to reveal the characterization of D+ HUS in Egyptian children. This is a retrospective study of all children with D+HUS admitted to a tertiary pediatric hospital in Egypt between 2007 and 2017. The study included epidemiological, clinical and laboratory data; management details; and outcomes. A cohort of 132 children aged 4months to 12 years was analyzed. Yearly incidence peaked in 2017, and spring showed the highest peak. All cases had a diarrheal prodrome that was bloody in 83% of the cases. Edema and decreased urine output were the most frequent presentations (50.3% and 42.4%, respectively). Escherichia coli was detected in 56 cases. Dialysis was performed in 102 cases. Eight patients died during acute illness, while five patients experienced long-term sequels. Lactate dehydrogenase (LDH) positively correlated with serum creatinine and negatively correlated with reticulocytic count. Univariate analysis showed that longer anuria duration, short duration between diarrheal illness and development of AKI (P = 0.001), leukocyte count above 20 × 109 cells/L (P ≤ 0.001), platelet count below 30 × 109 cells/L (P = 0.02), high LDH levels (P = 0.02) and hematocrit above 30% (P = 0.0001), need for dialysis (P = 0.03), and neurological involvement (P ≤ 0.001) were associated with unfavorable outcomes. This is the first report with a detailed insight into the epidemiology of D+HUS in Egyptian children. The incidence of D+HUS is increasing in our country due to increased awareness of the disease and the poor public health measures. Anuria duration, leukocyte count, and neurological involvement are predictors of poor outcome in the current work, and LDH is introduced as a marker of disease severity.
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