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Abstract: PO2334

Hemoglobinuria for the Early Identification of STEC-HUS in High-Risk Children

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Capone, Valentina, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Ardissino, Gianluigi, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Mancuso, Maria Cristina, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
  • Montini, Giovanni, Pediatric Nephrology, Dialysis and Transplantation, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
Background

Shigatoxin-producing Escherichia coli – associated hemolytic uremic syndrome (STEC-HUS) represents one of the main causes of acute kidney injury in children and can be associated with several extrarenal complications. Its management is entirely based on supportive care, which includes generous fluid infusions, since dehydrated patients have been described to have a worse outcome, compared to normo- and overhydrated patients. The present study aims at validating urine dipstick/urinalysis for hemoglobinuria as a early test to screen patients at high risk for the development of STEC-HUS (children with bloody diarrhea secondary to Shigatoxin – Stx - 2 or 1+2) for the early diagnosis of the disease.

Methods

Since 2010, a network 63 pediatric units (the ItalKid-HUS Network) has been developed in Northern Italy, with the aim of the early identification and management of STEC infections and STEC-HUS. Once a patient with bloody diarrhea (BD) is identified as Stx positive, he/she is rehydrated as appropriate and followed up with urine dipstick/urinalysis for hemoglobinuria until HUS develops or diarrhea resolves.
We here reviewed all the urine dipstick/urinalysis results from pediatric patients with Stx positivity either with BD only (Group 1) or with ongoing HUS (Group 2) from 2010 to 2019.

Results

A total of 100 children were eligible for the study. In Group 1, 22/63 patients had or developed hemoglobinuria while the remaining 41/63 were and remained negative. In 15/22 positive cases, blood tests ruled in a ongoing HUS, while in the remaining 7 the diagnosis was excluded. Among the 41 negative patients no one developed HUS. As expected, the 37 children in Group 2 (already ongoing HUS) all had hemoglobinuria at admission.

Conclusion

Hemoglobinuria shows a sensitivity of 100% (95% CI 93-100%) and a specificity of 85% (95% CI 74-93%), with positive predictive value of 68% and negative predictive value of 100% in diagnosing ongoing HUS. Thus, urine dipstick or urinalysis for the detection of hemoglobinuria can be proposed as an easy, fast, inexpensive and repeatable test to screen patients at high risk for the development of STEC-HUS and to start supportive treatment as soon as possible.