What if the Kidneys Don’t Recover?
Although kidney failure is usually temporary in post-diarrheal hemolytic uremic syndrome (D+HUS), some never regain sufficient kidney function. 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 (if the hyperfiltration injury is more severe/advanced). Renal hyperfiltration injury slowly grinds away at the remaining nephrons until more than 90 percent have been destroyed (converted to scar tissue), at which point dialysis or transplant is required. There is particular concern after 30 years of age when renal obsolescence, (as part of the normal ageing process), accelerates progressive hyperfiltration injury. Sufficient long-term experience to accurately predict the lifetime risk for end-stage renal disease (ESRD) is not available, but is at least 10 percent.