Long-term prognosis of hemolytic uremic syndrome and effective renal plasma flow
Long-term prognosis of hemolytic uremic syndrome and effective renal plasma flow. Hüseman D, Gellermann, Vollmer I, Ohde I, Devaux S, Ehrich JHH, Filler G. Pediatric Nephrology 1999;13:672-677.
Diarrhea-associated hemolytic uremic syndrome (D+HUS) remains the most common cause for acute renal failure in childhood. Several factors have been associated with a poor long-term prognosis but it is not yet clear what parameter is best used to identify patients at risk. Hemodynamic changes leading to glomerular hypertension and hyperfiltration are assumed responsible for secondary and continuous impairment of glomerular integrity in patients with renal injury. This study evaluated 127 children who survived the acute phase of D+HUS. There was no statistically significant difference between those with mild (no anuria) and moderate (anuria for 1-7 days) HUS in terms of the absence of renal sequelae. In contrast, the absence of renal sequelae was significantly lower in patients with severe (anuria greater than 7 days) HUS. The presence of hypertension during the initial phase also resulted in a lower probability of the absence of renal sequelae. In those with anuria for more than 7 days, hypertension during the acute phase was also associated with a lower probability of absence of renal sequelae. Central nervous system involvement in the initial phase did not influence the development of renal sequelae. Decreased kidney function, particularly as measured by effective renal plasma flow (ERPF), was found to be associated with renal sequelae in the second year of follow-up and reflects the risk for developing secondary deterioration of renal function. The authors recommend performing ERPF in the second year after diagnosis of D+HUS to identify patients at high risk for developing progressive renal disease.