Risk factors for poor renal prognosis in children with hemolytic uremic syndrome

A. Gianviti, Alberto E. Tozzi, Laura De Petris, Alfredo Caprioli, Lucilla Ravà, Alberto Edefonti, Gianluigi Ardissino, Giovanni Montini, Graziella Zacchello, Alfonso Ferretti, Carmine Pecoraro, Tommaso De Palo, Angela Caringella, Maurizio Gaido, Rosanna Coppo, Francesco Perfumo, Nunzia Miglietti, Ilse Ratsche, Rosa Penza, Giovambattista CapassoSilvio Maringhini, Salvatore Li Volti, Carmen Setzu, Marco Pennesi, Alberto Bettinelli, Leopoldo Peratoner, Ivana Pela, Elio Salvaggio, Giuliana Lama, Salvatore Maffei, Gianfranco Rizzoni

Research output: Contribution to journalArticle

Abstract

Many factors have been proposed as predictors of poor renal prognosis in children with hemolytic uremic syndrome (HUS), but their role is still controversial. Our aim was to detect the most reliable early predictors of poor renal prognosis to promptly identify children at major risk of bad outcome who could eventually benefit from early specific treatments, such as plasmapheresis. Prognostic factors identifiable at onset of HUS were evaluated by survival analysis and a proportional hazard model. These included age at onset, prodromal diarrhea (D), leukocyte count, central nervous system (CNS) involvement, and evidence of Shiga toxin-producing Escherichia coli (STEC) infection. Three hundred and eighty-seven HUS cases were reported; 276 were investigated for STEC infection and 189 (68%) proved positive. Age at onset, leukocyte count, and CNS involvement were not associated with the time to recovery. Absence of prodromal D and lack of evidence of STEC infection were independently associated with a poor renal prognosis; only 34% of patients D-STEC- recovered normal renal function compared with 65%-76% of D+STEC+, D+STEC- and D-STEC+ patients. In conclusion, absence of both D and evidence of STEC infection are needed to identify patients with HUS and worst prognosis, while D- but STEC+ patients have a significantly better prognosis.

Original languageEnglish
Pages (from-to)1229-1235
Number of pages7
JournalPediatric Nephrology
Volume18
Issue number12
DOIs
Publication statusPublished - Dec 2003

Keywords

  • Atypical hemolytic uremic syndrome
  • Classification
  • Hemolytic urenic syndrome
  • Long-term outcome
  • Prognostic factors
  • Shiga toxin-producing Escherichia coli

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

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  • Cite this

    Gianviti, A., Tozzi, A. E., De Petris, L., Caprioli, A., Ravà, L., Edefonti, A., Ardissino, G., Montini, G., Zacchello, G., Ferretti, A., Pecoraro, C., De Palo, T., Caringella, A., Gaido, M., Coppo, R., Perfumo, F., Miglietti, N., Ratsche, I., Penza, R., ... Rizzoni, G. (2003). Risk factors for poor renal prognosis in children with hemolytic uremic syndrome. Pediatric Nephrology, 18(12), 1229-1235. https://doi.org/10.1007/s00467-003-1262-6