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Hemolytic uremic syndrome: defining the need for long-term follow-up

Hemolytic uremic syndrome: defining the need for long-term follow-up. Small G, Watson AR, Evans JH, Gallagher J. Clinical Nephrology 1999;52(6):352-356.

ABSTRACT:

Diarrhea-associated hemolytic uremic syndrome (D+HUS) is a common cause of acute renal failure in children. Progressive renal insufficiency has been documented on prolonged follow-up of selected patients. However, it is uncertain whether all children recovering from varying degrees of HUS require long-term follow-up. The outcome of 114 patients with D+HUS presenting to a regional pediatric unit between 1986 and 1996 was reviewed in this paper. Of the 92 patients assessed at one year of follow-up, one remained on chronic peritoneal dialysis, five (5%) had moderate to severe chronic renal failure (CRF), 20 (22%) had mild CRF, and 66 (72%) had normal renal function. Of the 28 patients with a normal glomerular filtration rate (GFR) at one year, three deteriorated into mild CRF at five years. One patient had a single kidney and one had significant proteinuria at one year, factors which would have led to long-term follow-up. There was a significant negative correlation between number of days of dialysis and GFR at one year. The authors concluded that renal function at one year following HUS cannot be predicted with any certainty from the initial illness and should be formally assessed. However, renal function was within normal limits and remained stable between one and five years following HUS in most children. The results suggest that longer-term follow-up can probably be restricted to those with proteinuria, hypertension, abnormal ultrasound and/or impaired GFR at one year.