Alejandro Balestracci1, Luciana Meni Battaglia2, Ismael Toledo2, Laura Beaudoin2, Sandra Mariel Martin2, Nicolás Ariel Grisolía3, Ronald J Hogg4. 1. Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Autonomous City of Buenos Aires, CP, Argentina. abalestracci@yahoo.com.ar. 2. Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Autonomous City of Buenos Aires, CP, Argentina. 3. Department of Medicine, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Autonomous City of Buenos Aires, Argentina. 4. , Frisco, USA.
Abstract
BACKGROUND: Chronic kidney-related sequelae after STEC-HUS occur in 20-40% of patients. Hyperuricemia (HU) may cause acute and chronic toxicity involving the kidneys. We retrospectively assessed if there was an association between the presence of HU during the acute illness and that of kidney-related sequelae in children with STEC-HUS. METHODS: Children with STEC-HUS who had clinical and laboratory data at 2 years of follow-up were included in this case-control study. Univariate and multivariate analyses were performed between patients with (cases) or without (controls) kidney-related sequelae to identify factors associated with outcomes, including different measures of serum uric acid (sUA) (baseline level, peak, and duration of HU). HU was defined as sUA > 8 mg/dL. RESULTS: Of 86 patients included, 77.9% had HU. Patients with sequelae (n = 41) had a higher prevalence of HU (41/41 vs. 26/45, p < 0.01), higher baseline leukocyte count, serum creatinine (sCr), and sUA levels as well as lower sodium than controls. During hospitalization, cases also had higher sCr peak, sUA peak and duration of HU, requirement and duration of dialysis, extrarenal complications, and hypertension. By multivariate analysis, after adjusting for length of dialysis, only duration of HU (p = 0.0005; OR 1.7, 95% CI 1.27-2.36) remained as an independent predictor of sequelae, with a best cutoff of 5.5 days (AUC 0.95, specificity 80%, sensitivity 100%). CONCLUSIONS: The presence of HU is a common finding in children with STEC-HUS and its duration during the acute stage was associated with kidney-related sequelae, regardless of the duration of dialysis. A higher resolution version of the Graphical abstract is available as Supplementary Information.
BACKGROUND: Chronic kidney-related sequelae after STEC-HUS occur in 20-40% of patients. Hyperuricemia (HU) may cause acute and chronic toxicity involving the kidneys. We retrospectively assessed if there was an association between the presence of HU during the acute illness and that of kidney-related sequelae in children with STEC-HUS. METHODS: Children with STEC-HUS who had clinical and laboratory data at 2 years of follow-up were included in this case-control study. Univariate and multivariate analyses were performed between patients with (cases) or without (controls) kidney-related sequelae to identify factors associated with outcomes, including different measures of serum uric acid (sUA) (baseline level, peak, and duration of HU). HU was defined as sUA > 8 mg/dL. RESULTS: Of 86 patients included, 77.9% had HU. Patients with sequelae (n = 41) had a higher prevalence of HU (41/41 vs. 26/45, p < 0.01), higher baseline leukocyte count, serum creatinine (sCr), and sUA levels as well as lower sodium than controls. During hospitalization, cases also had higher sCr peak, sUA peak and duration of HU, requirement and duration of dialysis, extrarenal complications, and hypertension. By multivariate analysis, after adjusting for length of dialysis, only duration of HU (p = 0.0005; OR 1.7, 95% CI 1.27-2.36) remained as an independent predictor of sequelae, with a best cutoff of 5.5 days (AUC 0.95, specificity 80%, sensitivity 100%). CONCLUSIONS: The presence of HU is a common finding in children with STEC-HUS and its duration during the acute stage was associated with kidney-related sequelae, regardless of the duration of dialysis. A higher resolution version of the Graphical abstract is available as Supplementary Information.
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