BACKGROUND: Shigatoxin-associated hemolytic uremic syndrome (STEC-HUS) is a common thrombotic microangiopathy (TMA) in which central nervous system (CNS) involvement is responsible for the majority of deaths and for severe long-term sequelae. We have analyzed the role of hemoconcentration in disease severity. METHODS: This was a retrospective review of the records and laboratory data at presentation of all patients with STEC-HUS cases (n = 61) over a 10-year period. The patients were grouped into three severity classes: group A, comprising patients who did not require dialysis; group B, patients who were dialyzed without CNS involvement; group C, patients with CNS involvement. RESULTS: Patients with CNS involvement (group C) had a higher mean hemoglobin level (11.2 ± 2.3 g/dL) than those of group A or B ( 9.4 ± 2.1 and 7.5 ± 1.9 g/dL, respectively; p < 0.0001). We also observed that the higher the initial hemoglobin level, the more severe the long-term renal damage (p < 0.007). CONCLUSIONS: In patients with STEC-HUS, hemoconcentration and hypovolemia may be responsible for more severe ischemic organ damage (both short and long term) at disease onset, and these signs should be regarded as risk factors for CNS damage and for more severe TMA. Therefore, we recommend that hydration status should be actively monitored in HUS patients and that dehydration, when diagnosed, should be promptly corrected.
BACKGROUND: Shigatoxin-associated hemolytic uremic syndrome (STEC-HUS) is a common thrombotic microangiopathy (TMA) in which central nervous system (CNS) involvement is responsible for the majority of deaths and for severe long-term sequelae. We have analyzed the role of hemoconcentration in disease severity. METHODS: This was a retrospective review of the records and laboratory data at presentation of all patients with STEC-HUS cases (n = 61) over a 10-year period. The patients were grouped into three severity classes: group A, comprising patients who did not require dialysis; group B, patients who were dialyzed without CNS involvement; group C, patients with CNS involvement. RESULTS:Patients with CNS involvement (group C) had a higher mean hemoglobin level (11.2 ± 2.3 g/dL) than those of group A or B ( 9.4 ± 2.1 and 7.5 ± 1.9 g/dL, respectively; p < 0.0001). We also observed that the higher the initial hemoglobin level, the more severe the long-term renal damage (p < 0.007). CONCLUSIONS: In patients with STEC-HUS, hemoconcentration and hypovolemia may be responsible for more severe ischemic organ damage (both short and long term) at disease onset, and these signs should be regarded as risk factors for CNS damage and for more severe TMA. Therefore, we recommend that hydration status should be actively monitored in HUS patients and that dehydration, when diagnosed, should be promptly corrected.
Authors: A Schieppati; P Ruggenenti; R P Cornejo; F Ferrario; G Gregorini; P Zucchelli; E Rossi; G Remuzzi Journal: J Am Soc Nephrol Date: 1992-05 Impact factor: 10.121
Authors: Ryan S McKee; David Schnadower; Phillip I Tarr; Jianling Xie; Yaron Finkelstein; Neil Desai; Roni D Lane; Kelly R Bergmann; Ron L Kaplan; Selena Hariharan; Andrea T Cruz; Daniel M Cohen; Andrew Dixon; Sriram Ramgopal; Annie Rominger; Elizabeth C Powell; Jennifer Kilgar; Kenneth A Michelson; Darcy Beer; Martin Bitzan; Christopher M Pruitt; Kenneth Yen; Garth D Meckler; Amy C Plint; Stuart Bradin; Thomas J Abramo; Serge Gouin; April J Kam; Abigail Schuh; Fran Balamuth; Tracy E Hunley; John T Kanegaye; Nicholas E Jones; Usha Avva; Robert Porter; Daniel M Fein; Jeffrey P Louie; Stephen B Freedman Journal: Clin Infect Dis Date: 2020-04-10 Impact factor: 9.079
Authors: Laura F Alconcher; Paula A Coccia; Angela Del C Suarez; Marta L Monteverde; María Graciela Perez Y Gutiérrez; Paula M Carlopio; Mabel L Missoni; Alejandro Balestracci; Illiana Principi; Flavia B Ramírez; Patricia Estrella; Susana Micelli; Daniela C Leroy; Nahir E Quijada; Claudia Seminara; Marta I Giordano; Susana B Hidalgo Solís; Mariana Saurit; Alejandra Caminitti; Andrea Arias; Marta Rivas; Paula Risso; Miguel Liern Journal: Pediatr Nephrol Date: 2018-06-30 Impact factor: 3.714