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Long-term kidney outcomes in non-dialyzed children with Shiga-toxin Escherichia coli associated hemolytic uremic syndrome

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Abstract

Background

Long-term kidney outcomes of non-dialyzed children with Shiga-toxin Escherichia Coli hemolytic uremic syndrome (STEC-HUS) have been scantily studied. Therefore, we aimed to evaluate kidney outcomes and prognostic markers in these patients.

Methods

Non-dialyzed STEC-HUS patients followed for at least 5 years were included. They were grouped and compared according to kidney status at last visit: complete recovery (CR) or chronic kidney disease (CKD). Predictors of CKD evaluated at diagnosis were sex, age, leukocytes, hematocrit, hemoglobin (Hb), and serum creatinine (sCr). Peak sCr and time of follow-up were also analyzed.

Results

A total of 122 patients (62 female, median age at diagnosis 1.6 years) with a median follow-up of 11.3 years were included. At last visit, 82 (67%) had CR, 36 (30%) had CKD stage 1, and 4 (3%) had stage 2. No patient developed CKD stage 3–5. Median time to CKD was 5 years (IQR 3.1–8.76 years). Of the 122 patients, 18% evolved to CKD in the first 5 years, increasing to 28% at 10 and 33% at 20 years of follow-up. Serum Cr at diagnosis and peak sCr were significantly higher in patients with CKD than in those with CR.

Conclusions

One third of non-dialyzed STEC-HUS patients evolved to CKD after a median time of 5 years. However, CKD may appear even after 15 years of CR. Serum Cr was significantly higher among patients who evolved to CKD. These data reinforce that all non-dialyzed patients should be followed until adulthood.

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Acknowledgements

The authors gratefully acknowledge the assistance of Alejandro Balestracci, MD PhD, in the preparation of this manuscript and María Eugenia Elorza, PhD in Economics, and Fernanda Villarreal, PhD in Economics, for the statistical analysis done at Universidad Nacional del Sur.

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Authors and Affiliations

  1. Hospital Interzonal General Dr. José Penna, Bahía Blanca, Buenos Aires, Argentina

    Laura F. Alconcher, Lucas I. Lucarelli & Sabrina Bronfen

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  1. Laura F. Alconcher
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  2. Lucas I. Lucarelli
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  3. Sabrina Bronfen
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Correspondence to Laura F. Alconcher.

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This was an observational, retrospective study. The Review Boards and Ethics Committees approved this study. The requirement to obtain informed consent was waived by the institutional review boards.

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Alconcher, L.F., Lucarelli, L.I. & Bronfen, S. Long-term kidney outcomes in non-dialyzed children with Shiga-toxin Escherichia coli associated hemolytic uremic syndrome. Pediatr Nephrol 38, 2131–2136 (2023). https://doi.org/10.1007/s00467-022-05851-4

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