Prognostic significance of microalbuminuria in postdiarrheal hemolytic uremic syndrome

Lou‐Meda, Randall; Oakes, Robert S.; Gilstrap, Jarom; Williams, Colin J.; Siegler, Richard L.

doi:10.1007/s00467-006-0283-3

Cited by 26 publications

(17 citation statements)

References 21 publications

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“…Garg et al compared the presence of microalbuminuria in patients who had had HUS 3 years previously with an age-matched and gendermatched control group without HUS and concluded that a longer follow-up period is needed to determine if this finding has clinical relevance and utility [14]. Lou-Meda et al examined 35 patients with HUS and found that screening for microalbuminuria, within the first 6-18 months following an episode of HUS, improved the sensitivity for predicting later sequelae from 22% to 66.8%, compared to screening for overt proteinuria alone [15]. We agree with the authors that the clinical value of microalbuminuria as a predictor of long-term renal sequelae should be confirmed in a larger cohort with a longer period of follow-up.…”

Section: Discussionmentioning

confidence: 93%

Long-term follow-up of Argentinean patients with hemolytic uremic syndrome who had not undergone dialysis

et al. 2007

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We examined the records of patients with hemolytic uremic syndrome, who had not undergone dialysis during the acute stage, with the aims of evaluating: (1) the outcome after at least 5 years of follow-up; (2) the value of peak serum creatinine as a prognostic marker; (3) the relationship between outcome and time to normalization of renal function. From 1968 to 2000, 1,179 patients were assisted. Forty-two patients (3.6%) died during the acute stage, 478 patients (40.5%) required dialysis and 659 patients (55.9%) did not undergo dialysis; 529 non-dialysis patients were lost to follow-up. The remaining 130 patients were classified into four groups: group I, complete recovery; group II, with two subgroups, IIa, microalbuminuria, and IIb, proteinuria and/or high blood pressure, both with normal renal function; group III, chronic renal failure; and group IV, end-stage renal disease. We analyzed the relationship between final outcome and: (1) peak creatinine (the highest of at least two determinations) during the acute stage and (2) time to normalization of urea and/or creatinine after the acute stage. After a mean follow-up time of 147.1 months (range 60-362 months), group I had 83 patients (63.9%), group IIa had 27 (20.8%), group IIb had 15 (11.5%) and group III had 5 (3.8%). The value of peak serum creatinine concentration was available for 57 patients. On the last clinical visit, eight out of 26 (30.7%) patients with peak serum creatinine equal to or higher than 1.5 mg/dl were in groups IIb and III versus one out of 31 (3.2%) patients with lower values (P < or = 0.007). Finally, six out of 28 patients (21%) whose renal function had normalized after 15 days from diagnosis were in groups IIb-III versus 8/82 (9.7%) whose renal function had normalized within 15 days (P = 0.18). After a mean period of follow-up of 12 years, 15% of a selected patient group had developed proteinuria, high blood pressure or chronic renal failure, and 21% had developed microalbuminuria. Peak serum creatinine during the acute stage was useful as a prognostic indicator. Patients whose renal function required more time to normalize did not have a worse outcome.

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Section: Discussionmentioning

confidence: 93%

Long-term follow-up of Argentinean patients with hemolytic uremic syndrome who had not undergone dialysis

et al. 2007

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“…There was no stratification of patients depending on the degree of proteinuria among individual studies. Another study found that screening for microalbuminuria, within the first 6-18 months following an episode of post-diarrheal HUS, increased the sensitivity for predicting later sequelae from 22 to 66.7%, compared to screening for overt proteinuria alone [13].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Atypical Hemolytic Uremic Syndrome Presenting with Massive Proteinuria

Akhtar¹,

Triolo²

2015

AJMCR

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Atypical hemolytic uremic syndrome (HUS) is most commonly due to dysregulation of the alternative complement pathway. It is characterized by the classic triad of hemolytic anemia, thrombocytopenia, and acute kidney injury. Treatment includes supportive care including hemodialysis along with steroids, plasmapheresis, and eculizumab. We report a case of a 22 year old female who was diagnosed with atypical HUS and was also noted to have a severe degree of proteinuria, nearly 24 grams in the 24 hour urine collection. Proteinuria is observed in cases of atypical HUS because of the glomerular leakage of protein due to severe endothelial and epithelial injury. However, there is little data directly addressing the degree of proteinuria observed in these patients. This leads us to ask whether the degree of proteinuria has any prognostic significance or impact on disease progression and recovery.

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“…Monitoring the renal status of these children includes checking renal function and blood pressure and screening for proteinuria and albuminuria [21].…”

Section: Discussionmentioning

confidence: 99%

Levels of urinary transforming growth factor β-1 in children with D+ hemolytic uremic syndrome

2010

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About 25-50% of survivors of the acute phase of postdiarrheal hemolytic uremic syndrome (D+ HUS) develop chronic renal disease. Transforming growth factor beta-1 (TGFbeta-1) is the main fibrogenic growth factor in humans, and there is a significant correlation between its levels and the grade of interstitial fibrosis in chronic nephropathies. We hypothesized that increased urinary TGFbeta-1 may be an early indicator of sequelae in D+ HUS patients who show no sign of renal damage as determined by conventional diagnostic tests. We therefore compared the levels of TGFbeta-1 in urine collected from healthy controls (HC) (n = 18) with that from patients with a past history of D+ HUS (n = 39). We found that TGFbeta-1 excretion was significantly higher (p < 0.001) in the patient group (median level 73 pg/mg creatinine) than in the HC (median level 28 pg/mg creatinine). TGFbeta-1 excretion did not correlate with age, white blood cell count, length of oligoanuric period, maximum creatinine at the acute stage, or length of the follow-up. Since TGFbeta-1 excretion may reflect ongoing renal tissue damage, our results emphasize the need for the lifelong follow-up of patients with a past history of D+ HUS, even those showing apparent recovery. Long-term monitoring of this cohort is necessary to determine the clinical utility of our findings.

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Prognostic significance of microalbuminuria in postdiarrheal hemolytic uremic syndrome

Cited by 26 publications

References 21 publications

Long-term follow-up of Argentinean patients with hemolytic uremic syndrome who had not undergone dialysis

Long-term follow-up of Argentinean patients with hemolytic uremic syndrome who had not undergone dialysis

A Case Report of Atypical Hemolytic Uremic Syndrome Presenting with Massive Proteinuria

Levels of urinary transforming growth factor β-1 in children with D+ hemolytic uremic syndrome

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