Outcome and prognostic determinants in the hemolytic uremic syndrome of children.
ABSTRACT The late outcome in 89 children with the hemolytic-uremic syndrome (HUS) observed from 1971 to 1988 was analyzed up to 17 years after onset in relationship to various clinical and pathologic features at the onset of the disease. In the first 3 months after onset (acute phase) 69% of all children needed dialysis therapy. Fifteen children died, 9 during the acute phase and 6 subsequently. All surviving patients except 7 were reexamined and divided into five prognostic categories: recovery, residual renal symptoms with normal kidney function, moderate renal insufficiency, preterminal chronic renal failure (CRF) and end-stage renal disease (ESRD). The rate of recovery calculated by the life table method increased from 35% after 10 years in 1971-1979 to 68% in 1980-1988 (p < 0.001); it was lower in infants than in older children (44 vs. 63%; nonsignificant). Children with atypical HUS experienced more often preterminal CRF, ESRD or death than those with a typical (postenteropathic) form (33 vs. 17%; p < 0.05). If oliguria lasted < 7 days, 74% of patients recovered after 10 years versus 13% in the case of oliguria > 14 days or anuria > 7 days (p < 0.0005). The rate of recovery was also significantly smaller with the duration of dialysis treatment > 7 days, central nervous system involvement and requirement for antihypertensive therapy. In the entire series 7 patients developed preterminal CRF and 5 ESRD. Of 27 cases serially followed for 5-10 years after onset, a stable course was noted in 16, a subsequent improvement in 8 and deterioration in 3 leading to ESRD in 2.(ABSTRACT TRUNCATED AT 250 WORDS)
- SourceAvailable from: Marcelo Lisandro SignoriniMedicina 04/2013; 73(2):127-135. · 0.42 Impact Factor
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ABSTRACT: The management of Shiga toxin-producing Escherichia coli (STEC) infections is reviewed. Certain management practices optimize the likelihood of good outcomes, such as avoidance of antibiotics during the pre-hemolytic uremic syndrome phase, admission to hospital, and vigorous intravenous volume expansion using isotonic fluids. The successful management of STEC infections is based on recognition that a patient might have an STEC infection, and appropriate use of the microbiology laboratory. The timeliness of STEC identification cannot be overemphasized, because it avoids therapies prompted by inappropriate additional testing and directs the clinician to focus on effective management strategies. The opportunities during STEC infections to avert the worst outcomes are brief, and this article emphasizes practical matters relevant to making a diagnosis, anticipating the trajectory of illness, and optimizing care.Infectious disease clinics of North America 09/2013; 27(3):577-97. · 2.29 Impact Factor
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ABSTRACT: Purpose The aim is to describe the changes in initial findings of kidney ultrasound examinations in cases of hemolytic uremic syndrome (HUS) in children and to evaluate the respective importance of three sonographical parameters: echogenicity, corticomedullary differentiation (CMD), and kidney size. The correlation with laboratory parameters and proteinuria is analysed. Methods Reports containing ultrasound examinations and laboratory values from 1989 through 2012 of 39 children (13 cases of atypical HUS and 26 cases of typical HUS, first diagnosis at age 4 months to 10 2/12 years) suffering from HUS were analysed retrospectively. Ultrasound scans of the right kidney (n = 312) were evaluated with regard to the factors echogenicity, CMD, and kidney volume (ml, percentile). Laboratory parameters included serum creatinine, endogenous creatinine clearance in 24-h urine collection, eGFR according to Schwartz, and the protein content of the 24-h urine collection. Results All patients initially had increased echogenicity of the kidneys. All kidney volumes were ranged in the higher percentiles (the median percentile was the 85th). For assessment of long-term progression, the echogenicity proved to be of higher importance than the CMD due to a significant correlation between laboratory parameters of kidney function and the echogenicity. Conclusion Ultrasound examination of the kidneys is an important method in follow-up examinations of patients with HUS. Renal morphology correlates with laboratory parameters of kidney function.Journal of Medical Ultrasonics 04/2013; · 0.74 Impact Factor