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Pediatric Nephrology

, Volume 18, Issue 12, pp 1229–1235 | Cite as

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

  • Alessandra GianvitiEmail author
  • Alberto E. Tozzi
  • Laura De Petris
  • Alfredo Caprioli
  • Lucilla Ravà
  • Alberto Edefonti
  • Gianluigi Ardissino
  • Giovanni Montini
  • Graziella Zacchello
  • Alfonso Ferretti
  • Carmine Pecoraro
  • Tommaso De Palo
  • Angela Caringella
  • Maurizio Gaido
  • Rosanna Coppo
  • Francesco Perfumo
  • Nunzia Miglietti
  • Ilse Ratsche
  • Rosa Penza
  • Giovambattista Capasso
  • Silvio Maringhini
  • Salvatore Li Volti
  • Carmen Setzu
  • Marco Pennesi
  • Alberto Bettinelli
  • Leopoldo Peratoner
  • Ivana Pela
  • Elio Salvaggio
  • Giuliana Lama
  • Salvatore Maffei
  • Gianfranco Rizzoni
Original Article

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 DSTECrecovered normal renal function compared with 65%–76% of D+STEC+, D+STEC and DSTEC+ 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.

Keywords

Hemolytic uremic syndrome Shiga toxin-producing Escherichia coli Prognostic factors Long-term outcome Classification Atypical hemolytic uremic syndrome 

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Copyright information

© IPNA 2003

Authors and Affiliations

  • Alessandra Gianviti
    • 1
    • 23
    Email author
  • Alberto E. Tozzi
    • 2
  • Laura De Petris
    • 1
  • Alfredo Caprioli
    • 2
  • Lucilla Ravà
    • 2
  • Alberto Edefonti
    • 3
  • Gianluigi Ardissino
    • 3
  • Giovanni Montini
    • 4
  • Graziella Zacchello
    • 4
  • Alfonso Ferretti
    • 5
  • Carmine Pecoraro
    • 5
  • Tommaso De Palo
    • 6
  • Angela Caringella
    • 6
  • Maurizio Gaido
    • 7
  • Rosanna Coppo
    • 7
  • Francesco Perfumo
    • 8
  • Nunzia Miglietti
    • 9
  • Ilse Ratsche
    • 10
  • Rosa Penza
    • 11
  • Giovambattista Capasso
    • 12
  • Silvio Maringhini
    • 13
  • Salvatore Li Volti
    • 14
  • Carmen Setzu
    • 15
  • Marco Pennesi
    • 16
  • Alberto Bettinelli
    • 17
  • Leopoldo Peratoner
    • 18
  • Ivana Pela
    • 19
  • Elio Salvaggio
    • 20
  • Giuliana Lama
    • 21
  • Salvatore Maffei
    • 22
  • Gianfranco Rizzoni
    • 1
  1. 1.Division of Nephrology and DialysisBambino Gesù Children’s Hospital and Institute for Scientific ResearchRomeItaly
  2. 2.Istituto Superiore di SanitàRomeItaly
  3. 3.Dialysis Unit“De Marchi” Pediatric ClinicMilanItaly
  4. 4.Pediatric DepartmentUniversity of PaduaPaduaItaly
  5. 5.Division of Nephrology and DialysisSantobono HospitalNaplesItaly
  6. 6.Division of Nephrology and DialysisGiovanni XXIII HospitalBariItaly
  7. 7.Division of Nephrology and DialysisRegina Margherita HospitalTurinItaly
  8. 8.Division of Nephrology and DialysisG. Gaslini HospitalGenoaItaly
  9. 9.Pediatric ClinicSpedali CiviliBresciaItaly
  10. 10.Pediatric ClinicUniversity of AnconaAnconaItaly
  11. 11.Pediatric ClinicUniversity of BariBariItaly
  12. 12.Division of Nephrology and DialysisUniversity of NaplesNaplesItaly
  13. 13.Division of NephrologyDi Cristina HospitalPalermoItaly
  14. 14.Pediatric ClinicUniversity of CataniaCataniaItaly
  15. 15.Division of NephrologyBrotzu HospitalCagliariItaly
  16. 16.Burlo HospitalTriesteItaly
  17. 17.Pediatric UnitSan Leopoldo Mantic HospitalMerateItaly
  18. 18.Pediatric DivisionCivile HospitalPordenoneItaly
  19. 19.Pediatric ClinicMeyer HospitalFlorenceItaly
  20. 20.Pediatric ClinicCatholic UniversityRomeItaly
  21. 21.Pediatric Clinic“Federico II” UniversityNaplesItaly
  22. 22.Pediatric ClinicUniversity of PerugiaItaly
  23. 23.Division of Nephrology and DialysisBambino Gesù Children’s Hospital and Research InstituteItaly

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