Hemolytic uremic syndrome in Kuwaiti Arab children

Abstract

Twenty-five children with hemolytic uremic syndrome (HUS) were diagnosed between January 1985 and January 2000 in the Pediatric Nephrology Unit at Mubarak Al-Kabeer Hospital. Fourteen patients (56%) had typical (D+) HUS whereas 11 (44%) had atypical (D-) HUS. No bacterial or viral pathogens could be isolated in the majority of cases. The atypical HUS group had more severe anemia (P=0.03), which was significantly more prolonged than in the typical HUS group (P=0.0028). There was no significant difference between the two groups in the mean maximum serum creatinine (P=0.1), blood urea nitrogen values (P=0.8) and severity of leukocytosis (P=0.4). Anuria and the need for dialysis were not significantly different between the two groups (P=0.1 and 0.05, respectively). Mortality was significantly higher in the D- HUS patients (P<0.0001). Recurrence of HUS was documented in 63.3% of the D- HUS group compared to 14.2% of the D+ HUS group (P=0.0053). Family history of HUS was reported in 72.7% of the atypical HUS group and 14.2% of the typical HUS group. There were no significant differences in chronic renal sequelae between the two groups. In conclusion, the pathogenesis of HUS in Kuwaiti children appears to be influenced by genetic factors rather than certain environmental pathogens. Atypical HUS has a higher mortality rate, a definite familial tendency and a high relapse rate.

Chronic renal failure in Sudanese children: aetiology and outcomes

“…Multisystem disease accounted for only 2% of patients with CRF in our study, similar to published data from Indian and Kuwaiti populations [25][26][27]. Most of our patients with haemolytic uraemic syndrome recovered completely, and most of our systemic lupus erythematosus patients remained with normal function up to the time of the study.…”

Long-term Renal Prognosis of Diarrhea-Associated Hemolytic Uremic Syndrome

“…However smaller and possibly underpowered trials of plasma have not shown efficacy in diarrheaassociated HUS. 49,50 These metaregression results of the potential benefits of plasma are intriguing, recognizing their interpretation is complicated by their observational nature, analytic limitations, 74 trends influenced by a small number of studies, 45,52,54 and an absence of risk benefit assessment. Publication biases (in which studies with larger efficacy are more likely to be reported) may also exist.…”

“…Visually this trend seemed to be influenced by a small number of studies. 45,52,54 Sequelae After Milder Forms of Diarrhea-Associated HUS A few studies have suggested that patients with less severe forms of HUS, including those with a preserved urine output, may still demonstrate renal sequelae at follow-up. 23,25 For example, 2 of 5 patients with acute diarrhea-associated HUS and mild renal impairment (normal urine output, no dialysis) demonstrated hypertension and proteinuria at longterm follow-up.…”

“…Visually, this trend seemed to be influenced by a small number of studies. 45,52,54 LONG-TERM RENAL PROGNOSIS OF DIARRHEA-ASSOCIATED HUS as the cause of diarrhea-associated HUS, which has been limited even in studies during the last 15 years, seems necessary for the proper characterization of future cohorts. In addition, given that long-term sequelae have been described after milder forms of diarrheaassociated HUS, 23,25 research examining the incidence of renal disease after toxigenic E coli gastroenteritis seems essential.…”

AsPNA

“…The incidence of hemolytic uremic syndrome was estimated at 0.4 per 100,000 children per year. There was a high incidence of atypical hemolytic uremic syndrome (44 %) in a study of 25 Kuwaiti children below the age of 18 years, the majority of which was familial with consanguinity and first-cousin marriages playing a major role [96].…”