Typical pediatric hemolytic uremic syndrome in Algeria : prognostic factors

Abstract

HUS induced by shigatoxin-producing Escherichia coli (STEC HUS) is a serious disease requiring dialysis in 50% of cases, but renal recovery is frequent. Renal sequelae such as proteinuria, arterial hypertension (AH) and chronic renal failure (CRF) are possible in 30% of cases. Several prognostic factors have been identified, the main one being the duration of anuria. The aim of our paper is to describe the outcome of typical HUS in a cohort of patients followed over three years, and to detect reliable early predictors of poor prognosis in a specialized department in Algeria. Our study is observational and longitudinal. Inclusion criteria were the triad anemia-thrombocytopenia-acute renal failure (ARF) in children under sixteen years of age. Clinical and laboratory data were collected prospectively at baseline, at three months and every six months. A cohort of 23 children was recruited. The rate of recovery of renal function and death was 83% and 13%, respectively. There is a significant correlation between the presence of neurological damage, young age < 2 years and the occurrence of kidney damage. Late dialysis > 48 hours multiplies the relative risk of kidney damage by four. Event-free survival (death or occurrence of proteinuria, hypertension and/or CKD) is significantly related to young age and the time to dialysis > 48 hours. Delayed dialysis has a significant impact on overall survival. The latter factor increases the risk of death. Early diagnosis and management are important prognostic factors. Nephrological follow-up of all children with HUS is necessary in order to detect progression to CKD.