Risk factors for poor renal prognosis in children with hemolytic uremic syndrome
Risk factors for poor renal prognosis in children with hemolytic uremic syndrome. Gianviti A, Tozzi AE, DePetris L, Caprioli A, Rava L, Edefonti A, Ardissino G, Montini G, et al. Pediatric Nephrology 2003;18:1229-1235.
This Italian study was based on a national surveillance system of pediatric hemolytic uremic syndrome (HUS) cases in the previous 14 years. The authors investigated time to recovery and early predictors for poor renal outcomes, to determine who could benefit from early specific treatments such as plasmapheresis. Age at onset, leukocyte count, and central nervous system (CNS) involvement were not associated with time to recovery. The absence of prodromal diarrhea and lack of evidence of Shiga toxin-producing E. coli (STEC) infection were independently associated with a poor renal prognosis. Only 34% of diarrhea negative, STEC negative patients recovered normal renal function compared with 65% diarrhea positive/STEC negative, 67% diarrhea negative/STEC positive, and 76% diarrhea positive/STEC positive patients. The case fatality rate was also higher (10%) in the diarrhea negative, STEC negative group, compared to the other three groups (1% or less). The authors conclude that the classification of HUS could be revised to consider these subgroups, identified on the basis of both prodromal diarrhea and STEC infection. This classification may be useful for early identification of patients at high risk of poor prognosis who could benefit from plasmapheresis and be eligible for new therapeutic clinical trials.