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

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Abstract

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.

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Authors and Affiliations

  1. Division of Nephrology and Dialysis, Bambino Gesù Children’s Hospital and Institute for Scientific Research, Rome, Italy

    Alessandra Gianviti, Laura De Petris & Gianfranco Rizzoni

  2. Istituto Superiore di Sanità, Rome, Italy

    Alberto E. Tozzi, Alfredo Caprioli & Lucilla Ravà

  3. Dialysis Unit, “De Marchi” Pediatric Clinic, Milan, Italy

    Alberto Edefonti & Gianluigi Ardissino

  4. Pediatric Department, University of Padua, Padua, Italy

    Giovanni Montini & Graziella Zacchello

  5. Division of Nephrology and Dialysis, Santobono Hospital, Naples, Italy

    Alfonso Ferretti & Carmine Pecoraro

  6. Division of Nephrology and Dialysis, Giovanni XXIII Hospital, Bari, Italy

    Tommaso De Palo & Angela Caringella

  7. Division of Nephrology and Dialysis, Regina Margherita Hospital, Turin, Italy

    Maurizio Gaido & Rosanna Coppo

  8. Division of Nephrology and Dialysis, G. Gaslini Hospital, Genoa, Italy

    Francesco Perfumo

  9. Pediatric Clinic, Spedali Civili, Brescia, Italy

    Nunzia Miglietti

  10. Pediatric Clinic, University of Ancona, Ancona, Italy

    Ilse Ratsche

  11. Pediatric Clinic, University of Bari, Bari, Italy

    Rosa Penza

  12. Division of Nephrology and Dialysis, University of Naples, Naples, Italy

    Giovambattista Capasso

  13. Division of Nephrology, Di Cristina Hospital, Palermo, Italy

    Silvio Maringhini

  14. Pediatric Clinic, University of Catania, Catania, Italy

    Salvatore Li Volti

  15. Division of Nephrology, Brotzu Hospital, Cagliari, Italy

    Carmen Setzu

  16. Burlo Hospital, Trieste, Italy

    Marco Pennesi

  17. Pediatric Unit, San Leopoldo Mantic Hospital, Merate, Italy

    Alberto Bettinelli

  18. Pediatric Division, Civile Hospital, Pordenone, Italy

    Leopoldo Peratoner

  19. Pediatric Clinic, Meyer Hospital, Florence, Italy

    Ivana Pela

  20. Pediatric Clinic, Catholic University, Rome, Italy

    Elio Salvaggio

  21. Pediatric Clinic, “Federico II” University, Naples, Italy

    Giuliana Lama

  22. Pediatric Clinic, University of Perugia, Italy

    Salvatore Maffei

  23. Division of Nephrology and Dialysis, Bambino Gesù Children’s Hospital and Research Institute, Piazza Sant’Onofrio 4, 00165 Rome, Italy

    Alessandra Gianviti

Authors
  1. Alessandra Gianviti
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  2. Alberto E. Tozzi
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  3. Laura De Petris
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  4. Alfredo Caprioli
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  13. Angela Caringella
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  14. Maurizio Gaido
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  15. Rosanna Coppo
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  16. Francesco Perfumo
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  17. Nunzia Miglietti
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  18. Ilse Ratsche
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  19. Rosa Penza
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  20. Giovambattista Capasso
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  21. Silvio Maringhini
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  22. Salvatore Li Volti
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  23. Carmen Setzu
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  24. Marco Pennesi
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  25. Alberto Bettinelli
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  26. Leopoldo Peratoner
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  27. Ivana Pela
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  28. Elio Salvaggio
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  29. Giuliana Lama
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  30. Salvatore Maffei
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  31. Gianfranco Rizzoni
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Correspondence to Alessandra Gianviti.

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Gianviti, A., Tozzi, A.E., De Petris, L. et al. Risk factors for poor renal prognosis in children with hemolytic uremic syndrome. Pediatr Nephrol 18, 1229–1235 (2003). https://doi.org/10.1007/s00467-003-1262-6

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  • DOI: https://doi.org/10.1007/s00467-003-1262-6

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