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Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children

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Abstract

Hemorrhagic colitis (HC) is a severe manifestation of the hemolytic uremic syndrome (HUS). We performed a retrospective analysis of patients with HC with the following aims: (1) to characterize the clinicopathologic features; (2) to evaluate mortality rate; (3) to analyze severity of renal and central nervous system (CNS) disease. Patients with HC assisted between 1981–2009 were evaluated and compared with a control group of 137 patients without HC. Among 987 patients with diarrheal prodrome (D) + HUS, 54 (5.5%) presented HC. Clinical findings included abdominal pain (96%), distension (93%), hematochezia (44%), and abdominal mass (11%). Surgery was indicated in 35 patients (65%), and 17 (48.5%) required bowel resection. Transverse and ascending colon were most frequently affected. Macroscopic evaluation showed bowel necrosis (18) and perforation (12). Histologic evaluation (29) showed that 25 (86.2%) had necrosis of the affected segment (transmural in 21). A leukocyte count >20,000/mm3 and hematocrit >30% were more common in HC patients than in controls (p < 0.001 and p < 0.0001, respectively). Mortality rate was higher in HC patients (33.3%) than in controls (1.4%; p < 0.0001). Dialysis >10 days, seizures, and coma were more frequent in HC patients than in controls (p < 0.0001). In summary, most patients had prominent abdominal findings, and almost 2/3 patients required surgery. Transverse/ascending colon was most affected, and the main histologic finding was transmural necrosis. Higher hematocrit and leukocytosis were frequent. Mortality rate was extremely high, and most had long-lasting anuria and severe neurologic involvement.

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Acknowledgments

Part of this material was presented at the 15th Congress of the International Pediatric Nephrology Association (IPNA), August 29 – September 2, 2010, held in New York, NY, USA, and was published as an abstract # 352 (Pediatric Nephrology 2007; 25:1865)

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Authors and Affiliations

  1. Department of Nephrology, Hospital de Niños “Superiora Sor María Ludovica”, 14N° 1631, La Plata, 1900, Argentina

    Ricardo C. Rahman, Carlos J. Cobeñas, Oscar R. Amoreo, Javier D. Ruscasso, Ana P. Spizzirri, Angela del C. Suarez & Javier H. Zalba

  2. Department of Pathology, Hospital de Niños “Superiora Sor María Ludovica”, 14N° 1631, La Plata, 1900, Argentina

    Ricardo Drut

  3. Department of Radiology, Hospital de Niños “Superiora Sor María Ludovica”, 14N° 1631, La Plata, 1900, Argentina

    Celia Ferrari & Marcela C. Gatti

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  1. Ricardo C. Rahman
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  2. Carlos J. Cobeñas
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  3. Ricardo Drut
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  4. Oscar R. Amoreo
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  5. Javier D. Ruscasso
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  6. Ana P. Spizzirri
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  7. Angela del C. Suarez
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  8. Javier H. Zalba
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  9. Celia Ferrari
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  10. Marcela C. Gatti
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Correspondence to Ricardo C. Rahman.

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Rahman, R.C., Cobeñas, C.J., Drut, R. et al. Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children. Pediatr Nephrol 27, 229–233 (2012). https://doi.org/10.1007/s00467-011-1973-z

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  • DOI: https://doi.org/10.1007/s00467-011-1973-z

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