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• W2088724879 abstract "Many uncontrolled studies and a subsequent meta-analysis suggest that hemolytic uremic syndrome (HUS) with a positive history for diarrhea is associated with a significant increase in chronic renal disease. Two recent controlled studies that followed children with this type of HUS after Escherichia coli O157:H7 outbreaks, and where the controls were selected from a group exposed in the outbreak, gave conflicting results. To clarify this apparent difference, we retrospectively compared a cohort of 30 children with sporadic diarrhea-positive HUS with 30 healthy controls who had no history of bloody diarrhea or HUS and who had similar age and gender. Significantly more children with previous HUS than the controls had albuminuria over a median follow-up of 6.2 years. Of these albuminuric patients, one-third had macroalbuminuria compared with none of the controls. Following HUS, children were three times more prone to hypertension and prehypertension, although the difference was not statistically significant. Glomerular filtration rates, estimated by cystatin C, were significantly lower by 30 ml/min/1.73 m2. Thus, children with sporadic HUS with positive history of diarrhea compared with unexposed controls had a higher prevalence of chronic renal disease; results consistent with the meta-analysis. Prospective studies with appropriate controls are needed to completely resolve this issue. Many uncontrolled studies and a subsequent meta-analysis suggest that hemolytic uremic syndrome (HUS) with a positive history for diarrhea is associated with a significant increase in chronic renal disease. Two recent controlled studies that followed children with this type of HUS after Escherichia coli O157:H7 outbreaks, and where the controls were selected from a group exposed in the outbreak, gave conflicting results. To clarify this apparent difference, we retrospectively compared a cohort of 30 children with sporadic diarrhea-positive HUS with 30 healthy controls who had no history of bloody diarrhea or HUS and who had similar age and gender. Significantly more children with previous HUS than the controls had albuminuria over a median follow-up of 6.2 years. Of these albuminuric patients, one-third had macroalbuminuria compared with none of the controls. Following HUS, children were three times more prone to hypertension and prehypertension, although the difference was not statistically significant. Glomerular filtration rates, estimated by cystatin C, were significantly lower by 30 ml/min/1.73 m2. Thus, children with sporadic HUS with positive history of diarrhea compared with unexposed controls had a higher prevalence of chronic renal disease; results consistent with the meta-analysis. Prospective studies with appropriate controls are needed to completely resolve this issue. Diarrhea-positive hemolytic uremic syndrome (D+ HUS) is a major cause of acute kidney injury in children.1.Martin D.L. MacDonald K.L. White K.E. et al.The epidemiology and clinical aspects of the hemolytic uremic syndrome in Minnesota.N Engl J Med. 1990; 323: 1161-1167Crossref PubMed Scopus (182) Google Scholar, 2.Siegler R. Oakes R. Hemolytic uremic syndrome; pathogenesis, treatment, and outcome.Curr Opin Pediatr. 2005; 17: 200-204Crossref PubMed Scopus (121) Google Scholar Similar to other acute renal injuries, a HUS episode has the potential to decrease nephron endowment initially with subsequent increase in proteinuria, hypertension, and impaired glomerular filtration rate (GFR).3.Brenner B.M. Lawler E.V. Mackenzie H.S. The hyperfiltration theory: a paradigm shift in nephrology.Kidney Int. 1996; 49: 1774-1777Abstract Full Text PDF PubMed Scopus (662) Google Scholar A clear understanding of the risk of these chronic renal sequelae is important to guide the long-term follow-up after a HUS episode. Chronic renal sequelae after D+ HUS have been the subject of considerable debate. Some studies have reported minimal renal sequelae after D+ HUS.4.Small G. Watson A.R. Evans J.H. et al.Hemolytic uremic syndrome: defining the need for long-term follow-up.Clin Nephrol. 1999; 52: 352-356PubMed Google Scholar, 5.McLean M.M. Jones C.H. Sutherland D.A. Haemolytic-uraemic syndrome. A report of an outbreak.Arch Dis Child. 1966; 41: 76-81Crossref PubMed Scopus (35) Google Scholar, 6.Vermylen C. Bodart E. Ninane J. et al.The haemolytic uraemic syndrome of childhood: is living in Belgium a factor of good prognosis?.Acta Clin Belg. 1988; 43: 101-108PubMed Google Scholar However, most studies have found an increase in proteinuria, hypertension, and impaired GFR after D+ HUS.7.Cordero J. Baeza J. Fielbaum O. et al.[Hemolytic-uremic syndrome. Experience with 154 cases].Rev Chil Pediatr. 1990; 61: 235-242Crossref PubMed Google Scholar, 8.Schieppati A. Ruggenenti P. Cornejo R.P. et al.Renal function at hospital admission as a prognostic factor in adult hemolytic uremic syndrome. The Italian Registry of haemolytic uremic syndrome.J Am Soc Nephrol. 1992; 2: 1640-1644PubMed Google Scholar, 9.Cobenas C.J. Alconcher L.F. Spizzirri A.P. et al.Long-term follow-up of Argentinean patients with hemolytic uremic syndrome who had not undergone dialysis.Pediatr Nephrol. 2007; 22: 1343-1347Crossref PubMed Scopus (32) , 10.Spizzirri F.D. Rahman R.C. Bibiloni N. et al.Childhood hemolytic uremic syndrome in Argentina: long-term follow-up and prognostic features.Pediatr Nephrol. 1997; 11: 156-160Crossref PubMed Scopus (119) Google Scholar, 11.O'Regan S. Blais N. Russo P. et al.Hemolytic uremic syndrome: glomerular filtration rate, 6 to 11 years later measured by 99mTc DTPA plasma slope clearance.Clin Nephrol. 1989; 32: 217-220PubMed Google Scholar, 12.Huseman D. Gellermann J. Vollmer I. et al.Long-term prognosis of hemolytic uremic syndrome and effective renal plasma flow.Pediatr Nephrol. 1999; 13: 672-677Crossref PubMed Scopus (43) Google Scholar, 13.Campos A. Kim Y. Miller K. et al.Radionuclide studies of the kidney in children with hemolytic-uremic syndrome.Radiology. 1982; 145: 811-813Crossref PubMed Scopus (5) Google Scholar, 14.Gianantonio C.A. Vitacco M. Mendilaharzu F. et al.The hemolytic-uremic syndrome. Renal status of 76 patients at long-term follow-up.J Pediatr. 1968; 72: 757-765Abstract Full Text PDF PubMed Scopus (86) Google Scholar, 15.Tonshoff B. Sammet A. Sanden I. et al.Outcome and prognostic determinants in the hemolytic uremic syndrome of children.Nephron. 1994; 68: 63-70Crossref PubMed Scopus (80) Google Scholar, 16.Blahova K. Janda J. Kreisinger J. et al.Long-term follow-up of Czech children with D+ hemolytic-uremic syndrome.Pediatr Nephrol. 2002; 17: 400-403Crossref PubMed Scopus (13) Google Scholar, 17.Sorrenti L.Y. Lewy P.R. The hemolytic-uremic syndrome: experience at a center in the Midwest.Am J Dis Child. 1978; 132: 59-62Crossref PubMed Scopus (25) Google Scholar, 18.Kelles A. Van Dyck M. Proesmans W. Childhood haemolytic uraemic syndrome: long-term outcome and prognostic features.Eur J Pediatr. 1994; 153: 38-42Crossref PubMed Scopus (62) Google Scholar, 19.Hughes D.A. Beattie T.J. Murphy A.V. Haemolytic uraemic syndrome: 17 years' experience in a Scottish paediatric renal unit.Scott Med J. 1991; 36: 9-12PubMed Google Scholar, 20.de Jong M. Monnens L. Haemolytic-uraemic syndrome: a 10-year follow-up study of 73 patients.Nephrol Dial Transplant. 1988; 3: 379-382PubMed Google Scholar A meta-analysis based on these studies estimated chronic renal abnormalities (hypertension, overt proteinuria, GFR <80 ml/min/1.73 m2) in a quarter of children after an average follow-up of 4 years.21.Garg A.X. Suri R.S. Barrowman N. et al.Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome: a systematic review, meta-analysis, and meta-regression.JAMA. 2003; 290: 1360-1370Crossref PubMed Scopus (403) Google Scholar A major limitation of the studies in the meta-analysis is a lack of matched controls. This is an important consideration as inclusion of a control arm will reduce misestimating the risk of renal sequelae by controlling for unrelated asymptomatic proteinuria, prehypertension, and hypertension, which increase with the increase in obesity in otherwise healthy children.22.Jones C.A. Francis M.E. Eberhardt M.S. et al.Microalbuminuria in the US population: third National Health and Nutrition Examination Survey.Am J Kidney Dis. 2002; 39: 445-459Abstract Full Text Full Text PDF PubMed Scopus (343) Google Scholar, 23.Burgert T.S. Dziura J. Yeckel C. et al.Microalbuminuria in pediatric obesity: prevalence and relation to other cardiovascular risk factors.Int J Obes (Lond). 2006; 30: 273-280Crossref PubMed Scopus (64) Google Scholar, 24.Salvadori M. Sontrop J.M. Garg A.X. et al.Elevated blood pressure in relation to overweight and obesity among children in a rural Canadian community.Pediatrics. 2008; 122: e821-e827Crossref PubMed Scopus (94) Google Scholar To highlight this point further, a recent prospective study on D+ HUS after an E. coli O157:H7 outbreak with a matched control arm did not find a higher prevalence of overt proteinuria, hypertension, and chronic kidney disease in children after D+ HUS.25.Garg A.X. Salvadori M. Okell J.M. et al.Albuminuria and estimated GFR 5 years after Escherichia coli O157 hemolytic uremic syndrome: an update.Am J Kidney Dis. 2008; 51: 435-444Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar The results of this study suggested the possibility of an inflated estimate of chronic renal sequelae in the meta-analysis because the uncontrolled design of the included studies.21.Garg A.X. Suri R.S. Barrowman N. et al.Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome: a systematic review, meta-analysis, and meta-regression.JAMA. 2003; 290: 1360-1370Crossref PubMed Scopus (403) Google Scholar As the controls in this controlled study were exposed to E. coli O157:H7 during the outbreak, it is also possible that unrecognized subclinical renal injury in controls from the exposure of shiga toxin26.Hughes A.K. Ergonul Z. Stricklett P.K. et al.Molecular basis for high renal cell sensitivity to the cytotoxic effects of shigatoxin-1: upregulation of globotriaosylceramide expression.J Am Soc Nephrol. 2002; 13: 2239-2245Crossref PubMed Scopus (54) Google Scholar, 27.Hughes A.K. Stricklett P.K. Kohan D.E. Cytotoxic effect of shiga toxin-1 on human proximal tubule cells.Kidney Int. 1998; 54: 426-437Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 28.Van Setten P.A. van Hinsbergh V.W. Van den Heuvel L.P. et al.Verocytotoxin inhibits mitogenesis and protein synthesis in purified human glomerular mesangial cells without affecting cell viability: evidence for two distinct mechanisms.J Am Soc Nephrol. 1997; 8: 1877-1888PubMed Google Scholar or by the inclusion of subjects with undetected incomplete HUS in the control group29.Lopez E.L. Contrini M.M. Devoto S. et al.Incomplete hemolytic-uremic syndrome in Argentinean children with bloody diarrhea.J Pediatr. 1995; 127: 364-367Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 30.Koster F. Levin J. Walker L. et al.Hemolytic-uremic syndrome after shigellosis. Relation to endotoxemia and circulating immune complexes.N Engl J Med. 1978; 298: 927-933Crossref PubMed Scopus (252) Google Scholar could have masked the difference in renal abnormalities in the HUS patients versus their controls. Also, a further masking in the difference is possible due to the attenuation of acute renal injury in D+ HUS during an outbreak, by an early diagnosis, and by prompt fluid therapy.31.Ake J.A. Jelacic S. Ciol M.A. et al.Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion.Pediatrics. 2005; 115: e673-e680Crossref PubMed Scopus (185) Google Scholar On the basis of these assumptions, we hypothesized that renal outcome after an outbreak of D+ HUS assessed with exposed controls could be less severe than that after sporadic D+ HUS with unexposed controls. To test our hypothesis, we assessed the long-term renal sequelae of children, who had previous sporadic D+ HUS, and compared their outcomes with age and gender-matched healthy controls who had not knowingly been exposed to an E. coli O157:H7 outbreak. In all, 52 subjects with previous D+ HUS satisfying our inclusion criteria were identified from the records. A total of 22 could not be enrolled (15 not tracked, 1 moved out of province, and 6 did not consent). In those not enrolled, median age at the time of HUS episode was 3.4 years (range 7 months–16 years), and 20 (91%) of them aged below 12 years had HUS. In all, 15 (58%) were females; 18 (81%) had an E. coli documentation on stool culture, and 11 (50%) required dialysis initially. Finally, 30 subjects constituted the HUS group and were compared with 30 age and gender-matched healthy controls. The HUS patients and controls were matched for age (median 9 years; range 3–26) and gender (female 53%) as per the study design. These two groups were comparable with regard to body mass index (BMI) z-scores (P=0.93), and the proportion of underweight (P=0.90), overweight (P=0.54), and obese (P=0.29) subjects (Table 1).Table 1Characteristics of patients with previous HUS and the matched controlsHUS patients (n=30)Controls (n=30)P-valueMedian age; range (year)9.0; 3, 269.0; 3, 26NSAge distribution (years) <1219 (63.3%)19 (63.3%) 12–185 (16.6%)5 (16.6%) >186 (20.0%)6 (20.0%) Female (%)16 (53.3)16 (53.3)NS Family history of kidney disease (%)3 (10.0)1 (3.3)0.61 Previous dialysis (%)16 (53.3)— BMI z-scoreaz-scores and percentiles of BMI are reported for those aged below 18 years. For those who are 18 years and older, absolute values of BMI are stated.0.87±1.710.83±1.790.93 BMI percentileaz-scores and percentiles of BMI are reported for those aged below 18 years. For those who are 18 years and older, absolute values of BMI are stated.66.84±30.6164.07±36.080.77 BMI22.09±1.7224.36±4.370.28 Underweight (%)1 (3.3)3 (10)0.90 Overweight (%)4 (13.3)3 (10)0.54 Obese (%)7 (23.3)9 (30)0.29Abbreviations: BMI, body mass index; HUS, hemolytic uremic syndrome; NS, not significant.Data are expressed as mean±s.d., unless stated otherwise.For <18 years, underweight: <5th percentile; normal weight: 5th–85th percentiles; overweight: 85th–95th percentiles; and obese: ≥95th percentile.43http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/zscores/zscores.htm last accessed, 6 September 2009Google Scholar For ≥18 years, underweight: <18.5; normal: 18.5–24.9; overweight: 25–29.9; and obese ≥30.a z-scores and percentiles of BMI are reported for those aged below 18 years. For those who are 18 years and older, absolute values of BMI are stated. Open table in a new tab Abbreviations: BMI, body mass index; HUS, hemolytic uremic syndrome; NS, not significant. Data are expressed as mean±s.d., unless stated otherwise. For <18 years, underweight: <5th percentile; normal weight: 5th–85th percentiles; overweight: 85th–95th percentiles; and obese: ≥95th percentile.43http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/zscores/zscores.htm last accessed, 6 September 2009Google Scholar For ≥18 years, underweight: <18.5; normal: 18.5–24.9; overweight: 25–29.9; and obese ≥30. In the HUS group, median age at the time of HUS episode was 2.5 years (range 3 months–15.3 years). In all, 29 (97%) had HUS below 12 years of age and 16 (53%) required a short-term dialysis initially. None of them required dialysis after the initial recovery. A total of 24 (80%) patients were stool culture or verotoxin-positive. Median follow-up was 6.2 years (range 3.3–20.1). The HUS subjects and controls were compared for albuminuria, systolic and diastolic blood pressure (BP) z-scores, and estimated GFR (eGFR) by cystatin C and creatinine formulae (Table 2). The HUS subjects had a markedly higher urine albumin to creatinine ratio (median and 95% confidence interval, 2.70 (3.42, 17.25) versus 0.60 (0.72, 1.60), P=0.001) (Figure 1). In all, 40% of the HUS patients showed albuminuria in contrast to only 3% of controls (relative risk 12; P=0.001). One-third of HUS subjects with albuminuria had macroalbuminuria, whereas none of the control subjects had macroalbuminuria. The HUS group had a lower cystatin C eGFR (30 ml/min/1.73 m2; P=0.001) and creatinine eGFR (20 ml/min/1.73 m2; P=0.02) than controls. There was a trend towards higher BP after HUS (three times more hypertension and prehypertension, and a higher systolic and diastolic BP in HUS subjects), although the difference did not reach statistical significance. This may be because of five HUS subjects on angiotensin converting enzyme inhibitors (three for albuminuria and two for hypertension) versus none in controls (Table 2).Table 2Renal parameters in patients with previous HUS and the matched controlsData are expressed as mean±s.d., unless stated otherwise.HUS patients (n=30)Controls (n=30)P-valueSystolic BP z-score; median (95%CI)az-scores and percentiles of BP are reported for those aged below 18 years. For 18 years and older subjects, absolute values of BP are stated. For <18 years, BP levels were classified according to the fourth report (prehypertension: 90th and 95th percentile or in adolescents BP≥120/80 even if BP <90th percentile; hypertension: BP >95th percentile or antihypertensive medication already initiated for a diagnosed hypertension).51 For ≥18 years, BP was categorized according to the seventh JNC report (prehypertension: 120–139/80–89; hypertension: ≥140/90).52-0.25 (-0.52, 0.36)-0.07 (-1.22, 0.46)0.65Systolic BP percentileaz-scores and percentiles of BP are reported for those aged below 18 years. For 18 years and older subjects, absolute values of BP are stated. For <18 years, BP levels were classified according to the fourth report (prehypertension: 90th and 95th percentile or in adolescents BP≥120/80 even if BP <90th percentile; hypertension: BP >95th percentile or antihypertensive medication already initiated for a diagnosed hypertension).51 For ≥18 years, BP was categorized according to the seventh JNC report (prehypertension: 120–139/80–89; hypertension: ≥140/90).5248.31±32.046.18±24.050.82Systolic BP (mm Hg)120.85±11.96112.66±9.130.21Diastolic BP z-score; median (95%CI)az-scores and percentiles of BP are reported for those aged below 18 years. For 18 years and older subjects, absolute values of BP are stated. For <18 years, BP levels were classified according to the fourth report (prehypertension: 90th and 95th percentile or in adolescents BP≥120/80 even if BP <90th percentile; hypertension: BP >95th percentile or antihypertensive medication already initiated for a diagnosed hypertension).51 For ≥18 years, BP was categorized according to the seventh JNC report (prehypertension: 120–139/80–89; hypertension: ≥140/90).520.31 (-0.03, 0.65)-0.57 (-1.66, 0.51)0.09Diastolic BP percentileaz-scores and percentiles of BP are reported for those aged below 18 years. For 18 years and older subjects, absolute values of BP are stated. For <18 years, BP levels were classified according to the fourth report (prehypertension: 90th and 95th percentile or in adolescents BP≥120/80 even if BP <90th percentile; hypertension: BP >95th percentile or antihypertensive medication already initiated for a diagnosed hypertension).51 For ≥18 years, BP was categorized according to the seventh JNC report (prehypertension: 120–139/80–89; hypertension: ≥140/90).5258.44±24.9848.43±26.310.17Diastolic BP (mm Hg)73.66±9.7264.16±7.330.08Hypertension and prehypertension (%)9 (30)3 (10)0.10Hypertension (%)2 (6.6)0Prehypertension (%)7 (23.3)3 (10)Albumin/creatinine (mg/mmol); median (95%CI)2.70 (3.42, 17.25)0.60 (0.72, 1.60)0.001Albuminuria (%)12 (40)1 (3.3)0.001Microalbuminuria (%)8 (26.6)1 (3.3)Macroalbuminuria (%)4 (13.3)0Medications for blood pressure or albuminuria (%)bEnalapril, for albuminuria in three and for hypertension in two subjects.5 (16.6)0Creatinine-based eGFR117.84±33.08140.88±41.450.02Cystatin C (mg/l)0.76±0.200.62±0.090.002Cystatin C-based eGFR131.60±32.17159.67±28.320.001Abbreviations: BP, blood pressure; CI, confidence interval; eGFR, estimated GFR (ml/min/1.73 m2); HUS, hemolytic uremic syndrome.To convert urine albumin to creatinine ratio from mg/mmol to mg/g, multiply by 8.84; to convert GFR from ml/min/1.73 m2 to ml/s/1.73 m2, multiply by 0.01667.Microalbuminuria was defined as urine albumin/creatinine ratio of 3.4 mg/mmol (30 mg/g) to 33.9 mg/mmol (300 mg/g), and macroalbuminuria as urine albumin/creatinine ratio >33.9 mg/mmol (300 mg/g).Creatinine-based GFR was estimated by the Schwartz formula48.Filler G. Foster J. Acker A. et al.The Cockcroft-Gault formula should not be used in children.Kidney Int. 2005; 67: 2321-2324Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar in children and adolescents aged below 18 years, and by the modified diet in renal disease (MDRD) equation49.Levey A.S. Bosch J.P. Lewis J.B. et al.A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in Renal Disease Study Group.Ann Intern Med. 1999; 130: 461-470Crossref PubMed Scopus (13009) Google Scholar in 18 years or older subjects.Cystatin C-based estimated GFR was estimated by the Filler formula.39.Filler G. Lepage N. Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula?.Pediatr Nephrol. 2003; 18: 981-985Crossref PubMed Scopus (329) Google Scholara z-scores and percentiles of BP are reported for those aged below 18 years. For 18 years and older subjects, absolute values of BP are stated. For <18 years, BP levels were classified according to the fourth report (prehypertension: 90th and 95th percentile or in adolescents BP≥120/80 even if BP <90th percentile; hypertension: BP >95th percentile or antihypertensive medication already initiated for a diagnosed hypertension).51.National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.Pediatrics. 2004; 114: 555-576PubMed Google Scholar For ≥18 years, BP was categorized according to the seventh JNC report (prehypertension: 120–139/80–89; hypertension: ≥140/90).52.Chobanian A.V. Bakris G.L. Black H.R. et al.Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.Hypertension. 2003; 42: 1206-1252Crossref PubMed Scopus (10557) Google Scholarb Enalapril, for albuminuria in three and for hypertension in two subjects. Open table in a new tab Abbreviations: BP, blood pressure; CI, confidence interval; eGFR, estimated GFR (ml/min/1.73 m2); HUS, hemolytic uremic syndrome. To convert urine albumin to creatinine ratio from mg/mmol to mg/g, multiply by 8.84; to convert GFR from ml/min/1.73 m2 to ml/s/1.73 m2, multiply by 0.01667. Microalbuminuria was defined as urine albumin/creatinine ratio of 3.4 mg/mmol (30 mg/g) to 33.9 mg/mmol (300 mg/g), and macroalbuminuria as urine albumin/creatinine ratio >33.9 mg/mmol (300 mg/g). Creatinine-based GFR was estimated by the Schwartz formula48.Filler G. Foster J. Acker A. et al.The Cockcroft-Gault formula should not be used in children.Kidney Int. 2005; 67: 2321-2324Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar in children and adolescents aged below 18 years, and by the modified diet in renal disease (MDRD) equation49.Levey A.S. Bosch J.P. Lewis J.B. et al.A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in Renal Disease Study Group.Ann Intern Med. 1999; 130: 461-470Crossref PubMed Scopus (13009) Google Scholar in 18 years or older subjects. Cystatin C-based estimated GFR was estimated by the Filler formula.39.Filler G. Lepage N. Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula?.Pediatr Nephrol. 2003; 18: 981-985Crossref PubMed Scopus (329) Google Scholar The HUS patients with shorter follow-up (<5 years) were compared with those with a follow-up of ≥5 years. Age at the time of HUS and initial dialysis requirement were similar in the two groups (Table 3). Both groups did not differ in their urine albumin to creatinine ratio, BP z-scores, eGFR, and subjects with albuminuria, hypertension, prehypertension, and angiotensin converting enzyme inhibitor therapy.Table 3Renal parameters in patients with previous HUS with a follow-up <5 years and ≥5 yearsData are expressed as mean±s.d., unless stated otherwise.Follow-up <5 years (n=12)Follow-up ≥5 years (n=18)P-valueMedian age at the time of HUS; range (year)2.75; 0.70, 15.302.25; 0.30, 11.500.58Female (%)4 (33%)12 (66%)0.07Dialysis (%)6 (50%)10 (55%)0.70Systolic BP z-scoreaz-scores and percentiles of BP are reported for those aged below 18 years. For 18 years and older subjects, absolute values of BP are stated. For <18 years, BP levels were classified according to the fourth report (prehypertension: 90th and 95th percentile or in adolescents BP≥120/80 even if BP <90th percentile; hypertension: BP >95th percentile or antihypertensive medication already initiated for a diagnosed hypertension).51 For ≥18 years, BP was categorized according to the seventh JNC report (prehypertension: 120–139/80–89; hypertension: ≥140/90).52 median (95%CI)-0.25 (-0.75, 0.67)-0.35 (-0.76, 0.52)0.86Systolic BP percentileaz-scores and percentiles of BP are reported for those aged below 18 years. For 18 years and older subjects, absolute values of BP are stated. For <18 years, BP levels were classified according to the fourth report (prehypertension: 90th and 95th percentile or in adolescents BP≥120/80 even if BP <90th percentile; hypertension: BP >95th percentile or antihypertensive medication already initiated for a diagnosed hypertension).51 For ≥18 years, BP was categorized according to the seventh JNC report (prehypertension: 120–139/80–89; hypertension: ≥140/90).5247.08±33.3445.55±32.070.91Systolic BP (mm Hg)—120.85±10.14Diastolic BP z-scoreaz-scores and percentiles of BP are reported for those aged below 18 years. For 18 years and older subjects, absolute values of BP are stated. For <18 years, BP levels were classified according to the fourth report (prehypertension: 90th and 95th percentile or in adolescents BP≥120/80 even if BP <90th percentile; hypertension: BP >95th percentile or antihypertensive medication already initiated for a diagnosed hypertension).51 For ≥18 years, BP was categorized according to the seventh JNC report (prehypertension: 120–139/80–89; hypertension: ≥140/90).52 median (95%CI)0.30 (-0.20, 0.89)0.19 (-0.23, 0.79)0.84Diastolic BP percentileaz-scores and percentiles of BP are reported for those aged below 18 years. For 18 years and older subjects, absolute values of BP are stated. For <18 years, BP levels were classified according to the fourth report (prehypertension: 90th and 95th percentile or in adolescents BP≥120/80 even if BP <90th percentile; hypertension: BP >95th percentile or antihypertensive medication already initiated for a diagnosed hypertension).51 For ≥18 years, BP was categorized according to the seventh JNC report (prehypertension: 120–139/80–89; hypertension: ≥140/90).5234.08±32.9218.75±29.960.24Diastolic BP (mm Hg)—73.66±8.46Hypertension and prehypertension (%)4 (34%)5 (28%)0.18Hypertension (%)2 (17%)0Prehypertension (%)2 (17%)5 (28%)Albumin/creatinine (mg/mmol) median (95%CI)2.90 (-0.30, 20.44)1.60 (0.50, 20.50)0.95Albuminuria (%)5 (42%)7 (39%)0.86Microalbuminuria (%)3 (25%)5 (28%)Macroalbuminuria (%)2 (17%)2 (11%)Medications for blood pressure or albuminuriabEnalapril, for albuminuria in three and for hypertension in two subjects. (%)3 (25%)2 (11%)0.30Creatinine-based eGFR125.69±25.07113.04±36.980.32Cystatin C (mg/l)0.76±0.270.76±0.140.95Cystatin C-based eGFR137.06±43.07129.04±23.080.47Abbreviations: BP, blood pressure; CI, confidence interval; eGFR, estimated glomerular filtration rate (ml/min/1.73 m2); HUS, hemolytic uremic syndrome.Microalbuminuria was defined as urine albumin/creatinine ratio of 3.4 mg/mmol (30 mg/g) to 33.9 mg/mmol (300 mg/g), and macroalbuminuria as urine albumin/creatinine ratio >33.9 mg/mmol (300 mg/g).Creatinine-based GFR was estimated by the Schwartz formula48.Filler G. Foster J. Acker A. et al.The Cockcroft-Gault formula should not be used in children.Kidney Int. 2005; 67: 2321-2324Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar in children and adolescents aged below 18 years, and by the modified diet in renal disease (MDRD) equation49.Levey A.S. Bosch J.P. Lewis J.B. et al.A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in Renal Disease Study Group.Ann Intern Med. 1999; 130: 461-470Crossref PubMed Scopus (13009) Google Scholar in 18 years or older subjects.Cystatin C-based estimated GFR was estimated by the Filler formula.To convert urine albumin to creatinine ratio from mg/mmol to mg/g, multiply by 8.84; to convert GFR from ml/min/1.73 m2 to ml/s/1.73 m2, multiply by 0.01667.a z-scores and percentiles of BP are reported for those aged below 18 years. For 18 years and older subjects, absolute values of BP are stated. For <18 years, BP levels were classified according to the fourth report (prehypertension: 90th and 95th percentile or in adolescents BP≥120/80 even if BP <90th percentile; hypertension: BP >95th percentile or antihypertensive medication already initiated for a diagnosed hypertension).51.National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.Pediatrics. 2004; 114: 555-576PubMed Go" @default.
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• W2088724879 title "Chronic renal disease is more prevalent in patients with hemolytic uremic syndrome who had a positive history of diarrhea" @default.
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