A novel prognostic index in hemolytic uremic syndrome related to Shiga toxin–producing Escherichia coli

Battaglia, Luciana Meni; Balestracci, Alejandro

doi:10.1007/s00467-021-05355-7

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…Although many efforts have been made to develop tools for predicting severe course of acute disease and presence of sequelae, the severity of kidney injury during the acute phase remained the most relevant predictor of poor long-term outcome in our cohort. Recently reported tools use hemoglobin, LDH and creatinine levels to calculate the risk for development of severe acute disease [9,26,27]. The retrospective use of both scoring systems in our cohort showed no association with the presence of sequelae after 10 years.…”

Section: Discussionmentioning

confidence: 50%

Outcome 10 years after Shigatoxin-producing E. coli (STEC)-associated Hemolytic Uremic Syndrom: importance of long-term follow up

Rosales,

Kuppelwieser,

Giner

et al. 2023

Preprint

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Background Hemolytic uremic syndrome (HUS) is an important cause of acute kidney injury in children. HUS is known as an acute disease followed by complete recovery in most cases, but patients may still present kidney abnormalities after long periods of time. This study was performed to evaluate the long-term outcome of Shigatoxin-producing Escherichia coli-associated HUS (STEC-HUS) in pediatric patients, 10 years after the acute phase of disease and identify risk factors for long-term sequelae. Methods 619 patients under 18 years of age with HUS (490 STEC-positive, 79%) were registered in Austria and Germany over a 6-year period. The data of 138 STEC-HUS-patients was available after 10 years for analysis. Results Sixty-six% (n = 91, 95%CI0.57-0.73) of patients fully recovered showing no sequelae after 10 years. Thirty-four% (n = 47, 95%CI0.27-0.43) presented either with decreased glomerular filtration rate (24%), proteinuria (23%), hypertension (17%) or neurological symptoms (3%). Sixty-four% (n = 30) had sequelae 1 year after STEC-HUS, the rest presented sequelae unprecedented at the 2-year (n = 2), 3-year (n = 3), 5-year (n = 3) or 10-year (n = 9) follow-up. 17 patients (36.2%) without sequelae at 1-year follow-up presented kidney symptoms after a period of apparent total recovery, half of these (n = 9) between 5 and 10 years after STEC-HUS. Patients needing extracorporeal treatments during the acute phase were at higher risk of presenting symptoms after 10 years (p < 0.05). Conclusions Patients with STEC-HUS should be followed up regularly and for at least up to 10 years after the acute phase of disease, because long-term sequelae can still occur at that time. Characteristics that may help predict poor long-term outcome are an initial critical illness, marked by need of kidney replacement therapy or plasma treatment.

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Section: Discussionmentioning

confidence: 50%

Outcome 10 years after Shigatoxin-producing E. coli (STEC)-associated Hemolytic Uremic Syndrom: importance of long-term follow up

Rosales,

Kuppelwieser,

Giner

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Although many efforts have been made to develop tools for predicting a severe course of the acute disease and presence of sequelae, the severity of kidney injury during the acute phase remained the most relevant predictor of poor long-term outcome in our cohort. Recently reported tools use hemoglobin, LDH, and creatinine levels to calculate the risk for development of severe acute disease [ 9 , 26 , 27 ]. When we applied this score retrospectively to our cohort, no association with the presence of kidney symptoms after 10 years was observed.…”

Section: Discussionmentioning

confidence: 99%

Outcome 10 years after Shiga toxin-producing E. coli (STEC)-associated hemolytic uremic syndrome: importance of long-term follow-up

Rosales,

Kuppelwieser,

Giner

et al. 2024

Pediatr Nephrol

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Background Hemolytic uremic syndrome (HUS) is an important cause of acute kidney injury in children. HUS is known as an acute disease followed by complete recovery, but patients may present with kidney abnormalities after long periods of time. This study evaluates the long-term outcome of Shiga toxin-producing Escherichia coli-associated HUS (STEC-HUS) in pediatric patients, 10 years after the acute phase of disease to identify risk factors for long-term sequelae. Methods Over a 6-year period, 619 patients under 18 years of age with HUS (490 STEC-positive, 79%) were registered in Austria and Germany. Long-term follow-up data of 138 STEC-HUS-patients were available after 10 years for analysis. Results A total of 66% (n = 91, 95% CI 0.57–0.73) of patients fully recovered showing no sequelae after 10 years. An additional 34% (n = 47, 95% CI 0.27–0.43) presented either with decreased glomerular filtration rate (24%), proteinuria (23%), hypertension (17%), or neurological symptoms (3%). Thirty had sequelae 1 year after STEC-HUS, and the rest presented abnormalities unprecedented at the 2-year (n = 2), 3-year (n = 3), 5-year (n = 3), or 10-year (n = 9) follow-up. A total of 17 patients (36.2%) without kidney abnormalities at the 1-year follow-up presented with either proteinuria, hypertension, or decreased eGFR in subsequent follow-up visits. Patients needing extracorporeal treatments during the acute phase were at higher risk of presenting symptoms after 10 years (p < 0.05). Conclusions Patients with STEC-HUS should undergo regular follow-up, for a minimum of 10 years following their index presentation, due to the risk of long-term sequelae of their disease. An initial critical illness, marked by need of kidney replacement therapy or plasma treatment may help predict poor long-term outcome. Graphical abstract

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“…We thank Dr. Battaglia and Dr. Balestracci for their comments [1] on our recent article in Pediatric Nephrology regarding hemoconcentration and predictors in STEC-HUS [2].…”

Section: Dear Editorsmentioning

confidence: 99%

Response to Battaglia and Balestracci

Loos

2021

Pediatr Nephrol

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A novel prognostic index in hemolytic uremic syndrome related to Shiga toxin–producing Escherichia coli

Cited by 3 publications

References 4 publications

Outcome 10 years after Shigatoxin-producing E. coli (STEC)-associated Hemolytic Uremic Syndrom: importance of long-term follow up

Outcome 10 years after Shigatoxin-producing E. coli (STEC)-associated Hemolytic Uremic Syndrom: importance of long-term follow up

Outcome 10 years after Shiga toxin-producing E. coli (STEC)-associated hemolytic uremic syndrome: importance of long-term follow-up

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