Risk Factors for Short- and Long-Term Outcomes in Children With STEC-HUS/D(+) HUS: A Single-Center Experience

Background. Hemolytic uremic syndrome (HUS) is one of the common causes for acute kidney injury in childhood. Objective. The goals of our study were to identify risk factors for short-term complications and long-term outcomes of chronic kidney disease (CKD) in Shiga toxin–producing Escherichia coli (STEC)-HUS and other diarrhea positive (D(+)) HUS. Methods. Retrospective chart review was obtained of 58 pediatric patients treated for STEC-HUS and other D(+) HUS between February 2002 and January 2011. Results. Thirty-three patients (56.9%) required dialysis. Dialysis was more likely initiated if a patient was a female (P < .012), oliguric (urine output < 0.5 mL/kg/h, P < .0005), or hemoglobin (HGB) level >10 g/dL (P = .009) at admission. Neurological complications developed only among 5 dialyzed patients (P < .042), and were more common if the patient received hemodialysis (HD) compared with peritoneal dialysis (P < .0005). CKD was noted during the subsequent follow-up clinic visits in 5 patients (8.6%). Those who developed CKD received HD (P = .002), dialysis for >10 days (P = .0004), or HGB level >10 g/dL (P = .034) at admission. Conclusions. Children with STEC-HUS/D(+) HUS who may need dialysis are identified by female gender, lower urine output, higher serum creatinine level, and higher HGB at admission. They are at higher risk developing central nervous system complications especially if they needed HD. Children requiring >10 days of dialysis are at risk for development of CKD.