ESPN 51th Annual Meeting

ESPN 2018


 
Risk factors for complicated acute and for development of chronic kidney disease in children with acute diarrhea positive hemolytic uremic syndrome
JUDITH VANSICKLE 1 TARAK SRIVASTAVA 1 URI ALON 1

1- CHILDRENS MERCY HOSPITALS AND CLINICS
 
Introduction:

Hemolytic uremic syndrome (HUS) is most common cause of acute renal failure in childhood. The goals of our study were to identify risk factors for severe acute disease and for development of chronic kidney disease (CKD) at the time of initial presentation with diarrhea positive (D+) HUS.

Material and methods:

Retrospective chart review was obtained of 58 pediatric patients treated for D+ HUS between 2/2002-1/2011.

Results:

33 patients (56.9%) required dialysis. Dialysis was more likely initiated if a patient was a female (p<0.012), oliguric (urine output< 0.5 ml/kg/h) (p<0.0005) or had hemoglobin (HGB) level > 10 g/dl (p=0.009) at admission. Neurological complications developed only among 5 dialyzed patients (p < 0.042), and were more common if the patient received hemodialysis (HD) compared with peritoneal dialysis (PD) (p< 0.0005). CKD was noted during the subsequent follow up clinic visits in 5 patients (8.6%). Those, who developed CKD received hemodialysis (p=0.002) for > 10 days (p=0.0004) or had high HGB level at admission (p=0.034).

Conclusions:

Pediatric patients with D+ HUS who are likely to require dialysis may be identified by female gender, lower UOP, higher serum creatinine level, higher hemoglobin at admission and they are at higher risk developing CNS complications especially if they receive hemodialysis. CKD may be expected to develop in patients who required dialysis for > 10 days. Further studies are required to see if dialysis modalities have a role in the development of severe long term complications.