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Endothelial dysfunction during long-term follow-up in children with STEC hemolytic-uremic syndrome

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Abstract

Background

Shiga-toxin-producing Escherichia coli (STEC)-associated hemolytic-uremic syndrome (HUS) is a major cause of acute kidney injury (AKI), especially in children. Its long-term outcome with respect to endothelial damage remains largely elusive.

Methods

This was a cross-sectional study in 26 children who had suffered from STEC-HUS in the past and achieved a complete recovery of renal function (eGFR >90 ml/min/1.73 m2). Skin microcirculation after local heating was assessed by laser Doppler fluximetry, carotid-femoral pulse wave velocity (PWV), carotid intima media thickness (cIMT), 24-h ambulatory blood pressure, and angiopoietin (Ang) 1 and 2 serum levels after a median follow-up period of 6.1 years. The results were compared to those of healthy controls.

Results

All patients were normotensive, mean eGFR was 102 (range 91–154) ml/min/1.73 m2, and 13 of the 26 patients showed albuminuria. Endothelial dysfunction was present in 13 patients, and the mean serum Ang2/Ang1 ratio was increased compared to healthy children (each p < 0.05). In contrast, mean values for PWV and cIMT in the patients did not differ from those of the controls. Endothelial dysfunction was significantly associated with younger age at STEC-HUS manifestation, time after HUS, and presence of albuminuria.

Conclusion

The results of this study highlight the need for long-term follow-up of STEC-HUS patients even after complete recovery of eGFR and lack of hypertension with respect to microvascular damage.

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Author notes

    Authors and Affiliations

    1. Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

      Martin Kreuzer, Laura Sollmann, Stephan Ruben, Maren Leifheit-Nestler, Lars Pape & Dieter Haffner

    2. University Children’s Hospital, University of Rostock, Rostock, Germany

      Dagmar-Christiane Fischer

    Authors
    1. Martin Kreuzer
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    2. Laura Sollmann
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    3. Stephan Ruben
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    4. Maren Leifheit-Nestler
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    5. Dagmar-Christiane Fischer
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    6. Lars Pape
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    7. Dieter Haffner
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    Corresponding author

    Correspondence to Martin Kreuzer.

    Ethics declarations

    The study was approved by the local ethics committee and conducted in accordance with the Helsinki Declaration. Patients and/or their parents gave written and informed consent for participating in the study.

    Conflict of interest

    The authors declare no conflict of interest.

    Funding

    This study was supported by the Jackstädt-Foundation, Wuppertal, Germany.

    Additional information

    Martin Kreuzer and Laura Sollmann contributed equally to this work.

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    Kreuzer, M., Sollmann, L., Ruben, S. et al. Endothelial dysfunction during long-term follow-up in children with STEC hemolytic-uremic syndrome. Pediatr Nephrol 32, 1005–1011 (2017). https://doi.org/10.1007/s00467-016-3574-3

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    • DOI: https://doi.org/10.1007/s00467-016-3574-3

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