Early volume expansion and outcomes of hemolytic uremic syndrome

Gianluigi Ardissino, Francesca Tel, Ilaria Possenti, Sara Testa, Dario Consonni, Fabio Paglialonga, Stefania Salardi, Nicolò Borsa-Ghiringhelli, Patrizia Salice, Silvana Tedeschi, Pierangela Castorina, Rosaria Maria Colombo, Milena Arghittu, Laura Daprai, Alice Monzani, Rosangela Tozzoli, Maurizio Brigotti, Erminio Torresani

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC-HUS) is a severe acute illness without specific treatment except supportive care; fluid management is concentrated on preventing fluid overload for patients, who are often oligoanuric. Hemoconcentration at onset is associated with more severe disease, but the benefits of volume expansion after hemolytic uremic syndrome (HUS) onset have not been explored. Methods: All the children with STEC-HUS referred to our center between 2012 and 2014 received intravenous infusion targeted at inducing an early volume expansion (+10% of working weight) to restore circulating volume and reduce ischemic or hypoxic tissue damage. The short-and long-term outcomes of these patients were compared with those of 38 historical patients referred to our center during the years immediately before, when fluid intake was routinely restricted. Results: Patients undergoing fluid infusion soon after diagnosis showed a mean increase in body weight of 12.5% (vs 0%), had significantly better short-term outcomes with a lower rate of central nervous system involvement (7.9% vs 23.7%, P =.06), had less need for renal replacement therapy (26.3% vs 57.9%, P =.01) or intensive care support (2.0 vs. 8.5 days, P =.02), and needed fewer days of hospitalization (9.0 vs 12.0 days, P =.03). Long-term outcomes were also significantly better in terms of renal and extrarenal sequelae (13.2% vs 39.5%, P =.01). Conclusions: Patients with STEC-HUS had great benefit from early volume expansion. It is speculated that early and generous fluid infusions can reduce thrombus formation and ischemic organ damage, thus having positive effects on both short-and long-term disease outcomes.

Original languageEnglish
Article numbere20152153
JournalPediatrics
Volume137
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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