Hemolytic-uremic syndrome in adolescents
Hemolytic-uremic syndrome in adolescents. Siegler RL, Pavia AT, Cook JB. Archives of Pediatrics & Adolescent Medicine 1997;151(2):165-169.
Although the epidemiological characteristics and natural history of childhood and adult hemolytic uremic syndrome (HUS) have been well described, those that are associated with the syndrome when it occurs during the transition from childhood to adulthood have not been reported. This paper compared the epidemiological characteristics, clinical features, and outcome of 17 adolescents with HUS with those of 276 children with HUS. The study was based on data from the computerized Utah HUS registry. The HUS registry contains data on postdiarrheal and nondiarrheal HUS cases since 1970 in which the patients were younger than 18 years of age at the time of diagnosis and includes virtually all Utah cases as well as those referred from surrounding states. The 17 adolescent patients, who composed 5.8% of the study population, experienced a course of the disease that was similar to that of the younger patients. Diarrhea preceded HUS in approximately 90% of the patients in both groups. Laboratory values were similar in both groups. The hospital courses were also similar; seizures occurred in almost 20%, and hypertension and oligoanuric renal failure occurred in most cases. Two (12%) of the teenagers and 7 (2.4%) of the younger patients died during the acute phase of the syndrome; almost 50% of both groups experienced one or more chronic renal sequelae. End-stage renal disease occurred in 1 (5.8%) of the teenagers and 6 (2.2%) of the children. At follow-up one or more years (median, 5 years) after the onset of HUS, hypertension was present in 22% of the teenagers and 6.7% of the preteens. A below-normal glomerular filtration rate (GFR) was seen in approximately 30% of both groups; proteinuria was noted in approximately 25% of both groups. Approximately 10% in each group had a combination of proteinuria and a low GFR and are, therefore, at risk for eventual end-stage renal disease. In the Intermountain West region of the U.S., HUS in adolescents closely resembles that seen in children and the outcome is more favorable than that experienced by adults.