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Kidney Week

Abstract: PO2332

Typical Hemolytic Uremic Syndrome in Children: A Single-Center Experience

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Author

  • Shah, Siddharth A., University of Louisville, Prospect, Kentucky, United States
Background

Typical hemolytic-uremic syndrome (HUS) associated with diarrhea can be a fatal disease in children. Diarrhea and blood-stained stools are early symptoms. Oliguria and renal failure can occur anywhere from 3-7 days after onset of diarrhea. Intravenous (iv) fluids in the initial timeline of disease presentation may decrease the need for dialysis. Oligo-anuria at admission and leukocytosis is associated with poor outcomes during hospitalization. After recovery, there is a risk of long-term renal complications such as hypertension, proteinuria, and chronic kidney disease (CKD).

Methods

We performed a retrospective analysis of 43 children admitted with diarrhea associated with HUS at our center in the last ten years. The 'late presentation' defined as serum creatinine>1 mg/dL, oliguria, or anuria at admission. The primary outcome was the presence of long-term renal sequelae. It included proteinuria, hypertension, or chronic kidney disease (CKD) (eGFR <75 ml/min/1.73m2) after one year of disease-onset. The Chi-square and correlation analysis performed on the SPSS platform.

Results

Overall, 32/43 presented late in the disease course, 30/43 required dialysis (median: 8 d), and 8/43 had a recent history of NSAID use. The administration of dextrose and saline containing iv fluids in the early presentation was associated with the decreased requirement of dialysis (p=0.042), but the effect was not significant with NSAID use (p=0.064). Peak white blood cell count (Wbc) had a strong correlation with days of hospitalization (p<0.001). 10/43 children were lost to follow up. 13/33 children showed renal sequelae (includes 3 with CKD and 1 with ESRD who required kidney transplant) after one year of disease onset. Wbc count >20000 cells/mm3 (at p=0.001) and duration of dialysis>14 days (at p=0.002) were associated significantly with the primary outcome. 6/43 children were un-immunized. There was no mortality.

Conclusion

High peak WBC count may be a useful prognostic marker to evaluate the risk of long-term renal complications. These children need monitoring periodically after disease recovery. Early diagnosis and iv fluids before the onset of renal failure may help to prevent dialysis-related morbidity at the time of admission. More awareness is needed to discourage the use of NSAIDs following initial symptoms of HUS.