Werner Keenswijk1, Jill Vanmassenhove2, Ann Raes3, Evelyn Dhont4, Johan Vande Walle3. 1. Department of Pediatrics, Pediatric Nephrology, Ghent University Hospital, Gent, Belgium. keenswijkwerner@yahoo.com. 2. Department of Internal Medicine, Division of Nephrology, Ghent University Hospital, Gent, Belgium. 3. Department of Pediatrics, Pediatric Nephrology, Ghent University Hospital, Gent, Belgium. 4. Department of Pediatric Intensive Care, Ghent University Hospital, Gent, Belgium.
Abstract
Diarrhea-associated hemolytic uremic syndrome (D+HUS) is a common thrombotic microangiopathy during childhood and early identification of parameters predicting poor outcome could enable timely intervention. This study aims to establish the accuracy of BUN-to-serum creatinine ratio at admission, in addition to other parameters in predicting the clinical course and outcome. Records were searched for children between 1 January 2008 and 1 January 2015 admitted with D+HUS. A complicated course was defined as developing one or more of the following: neurological dysfunction, pancreatitis, cardiac or pulmonary involvement, hemodynamic instability, and hematologic complications while poor outcome was defined by death or development of chronic kidney disease. Thirty-four children were included from which 11 with a complicated disease course/poor outcome. Risk of a complicated course/poor outcome was strongly associated with oliguria (p = 0.000006) and hypertension (p = 0.00003) at presentation. In addition, higher serum creatinine (p = 0.000006) and sLDH (p = 0.02) with lower BUN-to-serum creatinine ratio (p = 0.000007) were significantly associated with development of complications. A BUN-to-sCreatinine ratio ≤40 at admission was a sensitive and highly specific predictor of a complicated disease course/poor outcome. CONCLUSION: A BUN-to-serum Creatinine ratio can accurately identify children with D+HUS at risk for a complicated course and poor outcome. What is Known: • Oliguria is a predictor of poor long-term outcome in D+HUS What is New: • BUN-to-serum Creatinine ratio at admission is an entirely novel and accurate predictor of poor outcome and complicated clinical outcome in D+HUS • Early detection of the high risk group in D+HUS enabling early treatment and adequate monitoring.
Diarrhea-associated hemolytic uremic syndrome (D+HUS) is a common thrombotic microangiopathy during childhood and early identification of parameters predicting poor outcome could enable timely intervention. This study aims to establish the accuracy of BUN-to-serum creatinine ratio at admission, in addition to other parameters in predicting the clinical course and outcome. Records were searched for children between 1 January 2008 and 1 January 2015 admitted with D+HUS. A complicated course was defined as developing one or more of the following: neurological dysfunction, pancreatitis, cardiac or pulmonary involvement, hemodynamic instability, and hematologic complications while poor outcome was defined by death or development of chronic kidney disease. Thirty-four children were included from which 11 with a complicated disease course/poor outcome. Risk of a complicated course/poor outcome was strongly associated with oliguria (p = 0.000006) and hypertension (p = 0.00003) at presentation. In addition, higher serum creatinine (p = 0.000006) and sLDH (p = 0.02) with lower BUN-to-serum creatinine ratio (p = 0.000007) were significantly associated with development of complications. A BUN-to-sCreatinine ratio ≤40 at admission was a sensitive and highly specific predictor of a complicated disease course/poor outcome. CONCLUSION: A BUN-to-serum Creatinine ratio can accurately identify children with D+HUS at risk for a complicated course and poor outcome. What is Known: • Oliguria is a predictor of poor long-term outcome in D+HUS What is New: • BUN-to-serum Creatinine ratio at admission is an entirely novel and accurate predictor of poor outcome and complicated clinical outcome in D+HUS • Early detection of the high risk group in D+HUS enabling early treatment and adequate monitoring.
Authors: Jan Menne; Martin Nitschke; Robert Stingele; Mariam Abu-Tair; Jan Beneke; Jörn Bramstedt; Jan P Bremer; Reinhard Brunkhorst; Veit Busch; Reinhard Dengler; Günther Deuschl; Klaus Fellermann; Helmut Fickenscher; Christoph Gerigk; Alexander Goettsche; Jobst Greeve; Carsten Hafer; Friedrich Hagenmüller; Hermann Haller; Stefan Herget-Rosenthal; Bernd Hertenstein; Christina Hofmann; Melanie Lang; Jan T Kielstein; Ulrich C Klostermeier; Johannes Knobloch; Markus Kuehbacher; Ulrich Kunzendorf; Hendrik Lehnert; Michael P Manns; Tobias F Menne; Tobias N Meyer; Claus Michael; Thomas Münte; Christine Neumann-Grutzeck; Jens Nuernberger; Hermann Pavenstaedt; Leyla Ramazan; Lutz Renders; Jonas Repenthin; Wolfgang Ries; Axel Rohr; Lars Christian Rump; Ola Samuelsson; Friedhelm Sayk; Bernhard M W Schmidt; Sabine Schnatter; Harald Schöcklmann; Stefan Schreiber; Cay U von Seydewitz; Jürgen Steinhoff; Sylvia Stracke; Sebastian Suerbaum; Andreas van de Loo; Martin Vischedyk; Karin Weissenborn; Peter Wellhöner; Monika Wiesner; Sebastian Zeissig; Jürgen Büning; Mario Schiffer; Tanja Kuehbacher Journal: BMJ Date: 2012-07-19