What if the Kidneys Don’t Recover?
Although kidney failure is usually temporary in D+HUS, some never regain sufficient kidney function to survive without immediate renal replacement therapy (dialysis, transplantation). Others initially regain enough function to not only survive but also to thrive, but experience progressive renal failure within a few years. A third group of survivors regain normal kidney function and appear to have recovered completely except that they have microalbuminuria or overt proteinuria (signs of hyperfiltration injury). Renal hyperfiltration injury slowly grinds away at the remaining nephrons until more than 90% have been destroyed (converted to scar tissue) at which point dialysis or transplant is required. There is particular concern during pregnancies and after 30 years of age when renal obsolescence, as part of the normal aging process, accelerates progressive hyperfiltration injury. Sufficient long-term experience to accurately predict the life-time risk for end-stage renal disease (ESRD) is not available, but is at least 10%.