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Early erythropoietin in post-diarrheal hemolytic uremic syndrome: a case–control study

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Abstract

Background

Although erythropoietin (EPO) deficiency has been reported in children with post-diarrheal hemolytic uremic syndrome (D + HUS), very limited clinical data on EPO use in this disease are currently available. In this case–control study we examined whether EPO administration would reduce the number of red blood cell (RBC) transfusions in D + HUS patients under our care.

Methods

Data from children treated exclusively with RBC transfusions (controls; n = 21) were retrospectively compared with data on those who also received EPO for the treatment of anemia (cases; n = 21).

Results

Both patient groups were similar in age (p = 0.9), gender (p = 0.12), weight (p = 1.00) and height (p = 0.66). Acute phase severity was also comparable, as inferred by the need for dialysis (p = 0.74), the duration of dialysis (p = 0.3), length of hospitalization (p = 0.81), presence of severe bowel (p = 1.00) or neurological injury (p = 0.69), arterial hypertension (p = 1.00) and death (p = 1.00). No differences in the hemoglobin level at admission (p = 0.51) and discharge (p = 0.28) were noted. Three children treated with EPO and two controls did not require any RBC transfusion (p = 1.00). Median number of RBC transfusions needed by cases and controls was 2 (p = 0.52).

Conclusion

Treatment with EPO did not reduce the number of RBC transfusions in D + HUS children. Assessment of EPO efficacy in D + HUS merits further studies.

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References

  1. Gianantonio C, Vitacco M, Mendilaharzu F, Rutti A, Mendilaharzu J (1964) The hemolytic uremic syndrome. J Pediatr 64:478–491

    Article  CAS  PubMed  Google Scholar 

  2. Scheiring J, Rosales A, Zimmerhackl LB (2010) Clinical practice. Today’s understanding of the haemolytic uraemic syndrome. Eur J Pediatr 169:7–13

    Article  PubMed  Google Scholar 

  3. Exeni R, Donato H, Rendo P, Antonuccio M, Rapetti MC, Grimoldi I, Exeni A, de Galvagni A, Trepacka E, Amore A (1998) Low levels of serum erythropoietin in children with endemic hemolytic uremic syndrome. Pediatr Nephrol 12:226–230

    Article  CAS  PubMed  Google Scholar 

  4. Scheiring J, Andreoli S, Zimmerhackl L (2008) Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Pediatr Nephrol 23:1749–1760

    Article  PubMed  Google Scholar 

  5. Iijima K, Kamioka I, Nozu K (2008) Management of diarrheaassociated hemolytic uremic syndrome in children. Clin Exp Nephrol 12:16–19

    Article  PubMed  Google Scholar 

  6. Pape L, Ahlenstiel T, Kreuzer M, Drube J, Froede K, Franke D, Ehrich JH, Haubitz M (2009) Early erythropoietin reduced the need for red blood cell transfusion in childhood hemolytic uremic syndrome: a randomized prospective pilot trial. Pediatr Nephrol 24:1061–1064

    Article  PubMed  Google Scholar 

  7. Spizzirri F, Rahman R, Bibiloni N, Ruscasso J, Amoreo O (1997) Childhood hemolytic uremic syndrome in Argentina: long-term follow-up and prognostic features. Pediatr Nephrol 11:156–160

    Article  CAS  PubMed  Google Scholar 

  8. Koshy SM, Geary DF (2008) Anemia in children with chronic kidney disease. Pediatr Nephrol 23:209–219

    Article  PubMed Central  PubMed  Google Scholar 

  9. Rahman R, Cobeñas C, Drut R, Amoreo O, Ruscasso J, Spizzirri A, Suarez A, Zalba J, Ferrari C, Gatti M (2012) Hemorrhagic colitis in postdiarrheal hemolytic uremic syndrome: retrospective analysis of 54 children. Pediatr Nephrol 27:229–233

    Article  PubMed  Google Scholar 

  10. de Buys Roessingh AS, de Lagausie P, Baudoin V, Loirat C, Aigrain Y (2007) Gastrointestinal complications of post-diarrheal hemolytic uremic syndrome. Eur J Pediatr Surg 17:328–334

    Article  PubMed  Google Scholar 

  11. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114[Suppl 2]:S555–S576

    Google Scholar 

  12. Brasher C, Siegler RL (1981) The hemolytic-uremic syndrome. West J Med 134:193–197

    CAS  PubMed Central  PubMed  Google Scholar 

  13. Schifferli A, von Vigier RO, Fontana M, Spartà G, Schmid H, Bianchetti MG, Rudin C, Unit SPS (2010) Hemolytic-uremic syndrome in Switzerland: a nationwide surveillance 1997–2003. Eur J Pediatr 169:591–598

    Article  PubMed  Google Scholar 

  14. Cavagnaro F, Gana JC, Lagomarsino E, Vogel A, Gederlini A (2005) Hemolytic uremic syndrome: the experience of a pediatric Center. Rev Med Chil 133:781–787

    Article  PubMed  Google Scholar 

  15. Lumbreras Fernández J, Cruz Rojo J, Iñigo Martín G, Muley Alonso R, Vara Martín J (2010) Hemolytic uremic syndrome: long term renal injury. An Pediatr (Barc) 72:309–316

    Article  Google Scholar 

  16. Srivastava RN, Moudgil A, Bagga A, Vasudev AS (1991) Hemolytic uremic syndrome in children in northern India. Pediatr Nephrol 5:284–288

    Article  CAS  PubMed  Google Scholar 

  17. Oh G, Lau KK (2012) Characteristics of children with sporadic hemolytic uremic syndrome in a single Northern California center. Int Urol Nephrol 44:1467–1472

    Article  PubMed  Google Scholar 

  18. Caletti MG, Balestracci A, Missoni M, Vezzani C (2013) Additive antiproteinuric effect of enalapril and losartan in children with hemolytic uremic syndrome. Pediatr Nephrol 28:745–750

    Article  PubMed  Google Scholar 

  19. Boyer O, Niaudet P (2011) Hemolytic uremic syndrome: new developments in pathogenesis and treatment. Int J Nephrol 2011:908407

    Article  PubMed Central  PubMed  Google Scholar 

  20. Walters MD, Matthei IU, Kay R, Dillon MJ, Barratt TM (1989) The polymorphonuclear leucocyte count in childhood haemolytic uraemic syndrome. Pediatr Nephrol 3:130–134

    Article  CAS  PubMed  Google Scholar 

  21. Coad N, Marshall T, Rowe B, Taylor CM (1991) Changes in the postenteropathic form of the hemolytic uremic syndrome in children. Clin Nephrol 35:10–16

    CAS  PubMed  Google Scholar 

  22. Lopez Devoto Lopez EL, Devoto S, Fayad A, Canepa C, Morrow AL, Cleary TG (1992) Association between severity of gastrointestinal prodrome and long-term prognosis in classic hemolytic-uremic syndrome. J Pediatr 120:210–215

    Article  Google Scholar 

  23. Gianviti A, Tozzi AE, De Petris L, Caprioli A, Ravà L, Edefonti A, Ardissino G, Montini G, Zacchello G, Ferretti A, Pecoraro C, De Palo T, Caringella A, Gaido M, Coppo R, Perfumo F, Miglietti N, Ratsche I, Penza R, Capasso G, Maringhini S, Li Volti S, Setzu C, Pennesi M, Bettinelli A, Peratoner L, Pela I, Salvaggio E, Lama G, Maffei S, Rizzoni G (2003) Risk factors for poor renal prognosis in children with hemolytic uremic syndrome. Pediatr Nephrol 18:1229–1235

    Article  PubMed  Google Scholar 

  24. Spinale JM, Ruebner RL, Copelovitch L, Kaplan BS (2013) Long-term outcomes of Shiga toxin hemolytic uremic syndrome. Pediatr Nephrol 28:2097–3105

    Article  PubMed  Google Scholar 

  25. Nathanson S, Kwon T, Elmaleh M, Charbit M, Launay EA, Harambat J, Brun M, Ranchin B, Bandin F, Cloarec S, Bourdat-Michel G, Piètrement C, Champion G, Ulinski T, Deschênes G (2010) Acute neurological involvement in diarrhea-associated hemolytic uremic syndrome. Clin J Am Soc Nephrol 5:1218–1228

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Oakes R, Siegler R, McReynolds M, Pysher T, Pavia A (2006) Predictors of fatality in postdiarrheal hemolytic uremic syndrome. Pediatrics 117:1656–1662

    Article  PubMed  Google Scholar 

  27. Hadtstein C, Schaefer F (2008) Hypertension in children with chronic kidney disease: pathophysiology and management. Pediatr Nephrol 23:363–371

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Unidad de Nefrología, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, CP 1270, Buenos Aires, Argentina

    Alejandro Balestracci, Sandra Mariel Martin, Ismael Toledo, Caupolican Alvarado & Raquel Eva Wainsztein

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  1. Alejandro Balestracci
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  2. Sandra Mariel Martin
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  3. Ismael Toledo
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  4. Caupolican Alvarado
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  5. Raquel Eva Wainsztein
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Correspondence to Alejandro Balestracci.

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Balestracci, A., Martin, S.M., Toledo, I. et al. Early erythropoietin in post-diarrheal hemolytic uremic syndrome: a case–control study. Pediatr Nephrol 30, 339–344 (2015). https://doi.org/10.1007/s00467-014-2911-7

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  • DOI: https://doi.org/10.1007/s00467-014-2911-7

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