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Childhood hemolytic uremic syndrome in Argentina: long-term follow-up and prognostic features
F D Spizzirri1, R C Rahman, N Bibiloni
1Renal Unit, Hospital de Niños Sor María Ludovica, La Plata, Argentina.
Insights
Hemolytic uremic syndrome (HUS) in children can lead to long-term kidney problems. Anuria duration and proteinuria at one year are key indicators of chronic renal sequelae in HUS patients.
Area of Science:
- Pediatric Nephrology
- Clinical Research
- Longitudinal Studies
Background:
- Hemolytic uremic syndrome (HUS) is a serious condition in infants and children.
- Understanding long-term outcomes and prognostic factors is crucial for managing HUS survivors.
Purpose of the Study:
- To define long-term evolution patterns of HUS in children.
- To identify predictors of chronic renal sequelae after acute HUS.
Main Methods:
- Retrospective analysis of 312 pediatric HUS patients admitted between 1968 and 1984.
- Long-term follow-up (mean 13 years) of 118 survivors.
- Correlation of acute phase variables with long-term renal outcomes.
Main Results:
- Four distinct outcome patterns were observed: complete recovery (62.7%), proteinuria/hypertension (17.7%), reduced creatinine clearance (16.1%), and end-stage renal failure (3.4%).
- Prolonged anuria (11+ days) was associated with a 69.2% rate of chronic renal sequelae.
- Proteinuria at the 1-year follow-up predicted renal abnormalities in 86% of patients at long-term assessment.
Conclusions:
- The duration of anuria during the acute phase and the presence of proteinuria at one year are significant prognostic indicators for long-term renal outcomes in pediatric HUS.
- While complete recovery is common, a substantial proportion of children experience chronic renal sequelae, emphasizing the need for long-term monitoring.
Abstract:
From January 1968 to December 1984, 312 infants and children with hemolytic uremic syndrome were admitted to our unit; 8 patients died (2.5%) during the acute phase; 118 children were followed as outpatients at yearly intervals for at least 10 years (mean follow-up 13 years, range 10-19.8 years). Four evolution patterns at the end of the follow-up were defined: group 1, complete recovery, 74 (62.7%); group 2, proteinuria with/without hypertension, 21 (17.7%); group 3, reduced creatinine clearance, often in conjunction with proteinuria and hypertension, 19 (16.1%); group 4, end-stage renal failure, 4 (3.4%). We investigated the association between several variables of the acute stage and the long-term evolution. Most non-anuric patients recovered completely (92.5%), while 38.4% of those with 1-10 days and 69.2% of those with 11 or more days of anuria had chronic renal sequelae. Similar results were found when analyzing the requirement for peritoneal dialysis. Of the patients with proteinuria at the 1-year control, 86% had renal abnormalities at the end of the follow-up. In our experience, although the final outcome was not predictable in every instance, the severity of acute renal failure-as determined by the days of anuria- and the presence of proteinuria 1 year after the acute phase were the most useful prognostic indicators.