Association between severity of gastrointestinal prodrome and long-term prognosis in classic hemolytic-uremic syndrome

López, Eduardo; Devoto, Susana; Fayad, Alicia; Cánepa, Carlos; Morrow, Ardythe L.; Cleary, Thomas G.

doi:10.1016/s0022-3476(05)80429-9

Cited by 45 publications

(29 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The polymorphonuclear leukocyte count found to be elevated in more severe disease [27,28] was not evaluated in this study. Severe gastrointestinal involvement was rare in our series and we can, therefore, not comment on the recent observation that the prognosis is worse in such cases [29].…”

Section: Discussioncontrasting

confidence: 70%

Outcome and Prognostic Determinants in the Hemolytic Uremic Syndrome of Children

Tönshoff

Sammet

Sanden

et al. 1994

Nephron

View full text Add to dashboard Cite

The late outcome in 89 children with the hemolytic-uremic syndrome (HUS) oberved 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 an 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. In conclusion, the study demonstrates a high incidence of chronic kidney disease in patients who have suffered from HUS. Late deterioration of renal function after apparent recovery underlines the need for continuing follow-up examinations for at least 10 years.

show abstract

Section: Discussioncontrasting

confidence: 70%

Outcome and Prognostic Determinants in the Hemolytic Uremic Syndrome of Children

Tönshoff

Sammet

Sanden

et al. 1994

Nephron

View full text Add to dashboard Cite

show abstract

“…In recent reports, it was found that the presence of bloody diarrheal prodrome was associated with severe disease. 9,21 Leukocytosis was present in 79% of our patients and low C3 was present in 39%. Recently it was demonstrated that a polymorphonuclear leukocytosis at presentation in D+HUS indicates severe disease and a poor prognosis.…”

Section: Discussionmentioning

confidence: 70%

Hemolytic Uremic Syndrome — Clinical Aspects and Outcome of an Outbreak: Report of 28 Cases

et al. 1995

View full text Add to dashboard Cite

“…In a large series of patients reported in the 1990s and followed for 16-18 years, Siegler et al [16,17,18] found that age <2 years was related to a poor prognosis, but not the absence of D. Moreover, leukocytosis and persistent oligoanuria were also related to a bad outcome. Lopez et al [19] retrospectively reviewed 509 Argentinian children up to 10 years. They showed that only severe colitis and rectal prolapse were related to the worst outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Many symptoms or clinical features have also been proposed as prognostic factors for HUS, but the results obtained in different studies were often controversial [1,2,14,15,16,17,18,19,20,21,22,23,24,25]. Moreover, to our knowledge, STEC infection is not usually considered a prognostic factor and the presence of D has generally been considered synonymous with the presence of STEC infection.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for poor renal prognosis in children with hemolytic uremic syndrome

Gianviti

Tozzi

Petris

et al. 2003

Pediatric Nephrology

View full text Add to dashboard Cite

Many factors have been proposed as predictors of poor renal prognosis in children with hemolytic uremic syndrome (HUS), but their role is still controversial. Our aim was to detect the most reliable early predictors of poor renal prognosis to promptly identify children at major risk of bad outcome who could eventually benefit from early specific treatments, such as plasmapheresis. Prognostic factors identifiable at onset of HUS were evaluated by survival analysis and a proportional hazard model. These included age at onset, prodromal diarrhea (D), leukocyte count, central nervous system (CNS) involvement, and evidence of Shiga toxin-producing Escherichia coli (STEC) infection. Three hundred and eighty-seven HUS cases were reported; 276 were investigated for STEC infection and 189 (68%) proved positive. Age at onset, leukocyte count, and CNS involvement were not associated with the time to recovery. Absence of prodromal D and lack of evidence of STEC infection were independently associated with a poor renal prognosis; only 34% of patients D(-)STEC(- )recovered normal renal function compared with 65%-76% of D(+)STEC(+), D(+)STEC(-) and D(-)STEC(+ )patients. In conclusion, absence of both D and evidence of STEC infection are needed to identify patients with HUS and worst prognosis, while D(-) but STEC(+) patients have a significantly better prognosis.

show abstract

Association between severity of gastrointestinal prodrome and long-term prognosis in classic hemolytic-uremic syndrome

Cited by 45 publications

References 16 publications

Outcome and Prognostic Determinants in the Hemolytic Uremic Syndrome of Children

Outcome and Prognostic Determinants in the Hemolytic Uremic Syndrome of Children

Hemolytic Uremic Syndrome — Clinical Aspects and Outcome of an Outbreak: Report of 28 Cases

Risk factors for poor renal prognosis in children with hemolytic uremic syndrome

Contact Info

Product

Resources

About