TY - JOUR
T1 - Hemoconcentration
T2 - a major risk factor for neurological involvement in hemolytic uremic syndrome
AU - Ardissino, Gianluigi
AU - Daccò, Valeria
AU - Testa, Sara
AU - Civitillo, Cristina Felice
AU - Tel, Francesca
AU - Possenti, Ilaria
AU - Belingheri, Mirco
AU - Castorina, Pierangela
AU - Bolsa-Ghiringhelli, Nicolò
AU - Tedeschi, Silvana
AU - Paglialonga, Fabio
AU - Salardi, Stefania
AU - Consonni, Dario
AU - Zoia, Elena
AU - Salice, Patrizia
AU - Chidini, Giovanna
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Background: Shigatoxin-associated hemolytic uremic syndrome (STEC-HUS) is a common thrombotic microangiopathy (TMA) in which central nervous system (CNS) involvement is responsible for the majority of deaths and for severe long-term sequelae. We have analyzed the role of hemoconcentration in disease severity. Methods: This was a retrospective review of the records and laboratory data at presentation of all patients with STEC-HUS cases (n = 61) over a 10-year period. The patients were grouped into three severity classes: group A, comprising patients who did not require dialysis; group B, patients who were dialyzed without CNS involvement; group C, patients with CNS involvement. Results: Patients with CNS involvement (group C) had a higher mean hemoglobin level (11.2 ± 2.3 g/dL) than those of group A or B (9.4 ± 2.1 and 7.5 ± 1.9 g/dL, respectively; p <0.0001). We also observed that the higher the initial hemoglobin level, the more severe the long-term renal damage (p <0.007). Conclusions: In patients with STEC-HUS, hemoconcentration and hypovolemia may be responsible for more severe ischemic organ damage (both short and long term) at disease onset, and these signs should be regarded as risk factors for CNS damage and for more severe TMA. Therefore, we recommend that hydration status should be actively monitored in HUS patients and that dehydration, when diagnosed, should be promptly corrected.
AB - Background: Shigatoxin-associated hemolytic uremic syndrome (STEC-HUS) is a common thrombotic microangiopathy (TMA) in which central nervous system (CNS) involvement is responsible for the majority of deaths and for severe long-term sequelae. We have analyzed the role of hemoconcentration in disease severity. Methods: This was a retrospective review of the records and laboratory data at presentation of all patients with STEC-HUS cases (n = 61) over a 10-year period. The patients were grouped into three severity classes: group A, comprising patients who did not require dialysis; group B, patients who were dialyzed without CNS involvement; group C, patients with CNS involvement. Results: Patients with CNS involvement (group C) had a higher mean hemoglobin level (11.2 ± 2.3 g/dL) than those of group A or B (9.4 ± 2.1 and 7.5 ± 1.9 g/dL, respectively; p <0.0001). We also observed that the higher the initial hemoglobin level, the more severe the long-term renal damage (p <0.007). Conclusions: In patients with STEC-HUS, hemoconcentration and hypovolemia may be responsible for more severe ischemic organ damage (both short and long term) at disease onset, and these signs should be regarded as risk factors for CNS damage and for more severe TMA. Therefore, we recommend that hydration status should be actively monitored in HUS patients and that dehydration, when diagnosed, should be promptly corrected.
KW - Children
KW - Diarrhea
KW - Hemolytic uremic syndrome
KW - Neurological involvement
KW - Shigatoxin
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U2 - 10.1007/s00467-014-2918-0
DO - 10.1007/s00467-014-2918-0
M3 - Article
C2 - 25149851
AN - SCOPUS:84941568588
VL - 30
SP - 345
EP - 352
JO - Pediatric Nephrology
JF - Pediatric Nephrology
SN - 0931-041X
IS - 2
ER -