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Long-term outcomes of Shiga toxin hemolytic uremic syndrome

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Abstract

Shiga toxin-producing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) is an important cause of acute kidney injury (AKI). The outcomes of STEC HUS have improved, and the acute mortality rate in children is 1–4 %. About 70 % of patients recover completely from the acute episode and the remainder have varying degrees of sequelae. Only a few retrospective studies have reviewed these patients over long periods. Methodological flaws include a lack of strict definitions, changing modes of treatment, ascertainment bias and loss of subjects to follow-up. The kidneys bear the brunt of the long-term damage: proteinuria (15–30 % of cases); hypertension (5–15 %); chronic kidney disease (CKD; 9–18 %); and end-stage kidney disease (ESKD; 3 %). A smaller number have extra-renal sequelae: colonic strictures, cholelithiasis, diabetes mellitus or brain injury. Most renal sequelae are minor abnormalities, such as treatable hypertension and/or variable proteinuria. Most of the patients who progress to ESKD do not recover normal renal function after the acute episode. Length of anuria (more than 10 days) and prolonged dialysis are the most important risk factors for a poor acute and long-term renal outcome. After the acute episode all patients must be followed for at least 5 years, and severely affected patients should be followed indefinitely if there is proteinuria, hypertension or a reduced glomerular filtration rate (GFR).

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Joann M. Spinale, Rebecca L. Ruebner, Lawrence Copelovitch & Bernard S. Kaplan

  2. Division of Nephrology, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Bernard S. Kaplan

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  1. Joann M. Spinale
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  3. Lawrence Copelovitch
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Correspondence to Bernard S. Kaplan.

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Answers

1.C

2.C

3.B

4.B

5.A

Multiple choice questions (answers are provided following the reference list)

Multiple choice questions (answers are provided following the reference list)

  1. 1.

    Long-term sequelae for STEC HUS include all of the following EXCEPT:

    1. a)

      Diabetes

    2. b)

      Hypertension

    3. c)

      Kidney stones

    4. d)

      Proteinuria

  2. 2.

    The percentage of patients who have long-term sequelae after STEC HUS is closest to:

    1. a)

      50%

    2. b)

      75%

    3. c)

      30%

    4. d)

      5%

  3. 3.

    Of the following, which risk factor is MOST predictive of long-term sequelae in STEC HUS?

    1. a)

      Leukocytosis

    2. b)

      Duration of anuria

    3. c)

      Age

    4. d)

      Anemia

    5. e)

      Use of antibiotics

  4. 4.

    The acute mortality rate of STEC HUS is closest to:

    1. a)

      Less than 1 %

    2. b)

      1–4 %

    3. c)

      5–10 %

    4. d)

      10–15 %

  5. 5.

    Treatment of STEC HUS includes all of the following EXCEPT:

    1. a)

      Plasmapheresis

    2. b)

      Early volume expansion

    3. c)

      Dialysis

    4. d)

      Blood transfusions

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Spinale, J.M., Ruebner, R.L., Copelovitch, L. et al. Long-term outcomes of Shiga toxin hemolytic uremic syndrome. Pediatr Nephrol 28, 2097–2105 (2013). https://doi.org/10.1007/s00467-012-2383-6

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