Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome, a systematic review
Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome, a systematic review, meta-analysis, and meta-regression. Garg AX, Suri RS, Barrowman N, Rehman F, Matsell D, Rosas-Arellano MP, Salvadori M, Haynes RB, Clark WF. JAMA 2003;290(10):1360-1370.
Hemolytic uremic syndrome (HUS), especially in children, is a major cause of acute renal failure worldwide. The long-term renal prognosis of diarrhea-associated HUS is controversial, with a wide range of results reported in the literature. This paper synthesizes the findings of 49 studies from 18 countries regarding the long-term renal prognosis of nearly 3500 children and adolescents with diarrhea-associated HUS who were followed for an average of four years. Permanent end-stage renal disease (ESRD) ranged from 0% to 17%, with a pooled incidence of 3%, while the incidence of death ranged from 0% to 23% with a pooled estimate of 9%. The majority of those outcomes occurred during the acute phase of HUS. Further, a higher severity of acute illness was strongly associated with worse long-term prognosis. Studies with a higher proportion of patients with central nervous system symptoms, such as coma, seizures, or stroke, had a higher proportion of patients who died or developed permanent ESRD. Those studies with a higher proportion of patients requiring acute dialysis not only had a higher proportion of patients who died or developed permanent ESRD, but also a higher proportion of patients with long-term renal sequelae. One or more years after diarrhea-associated HUS, patients with renal recovery appeared to have excellent prognosis. With respect to treatment, living within 63 miles (100km) from a tertiary center, and early recognition and treatment, including dialysis, were associated with a better prognosis. The authors recommend multicenter, multinational, clinical trials to demonstrate the benefits of any therapy, particularly plasma exchange, on these outcomes.