Clinical and Serological Predicting Factors for Dialysis in Infants and Children with Hemolytic Uremic Syndrome Referred to Qazvin Children's Hospital in 2020-2021

Document Type : Original Article(s)

Authors

1 Clinical Research Development Unit, Booalisina Hospital, Qazvin University of Medical Sciences, Qazvin, Iran

2 Assistant Professor, Children Growth Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran

3 Associate Professor, Clinical Research Development Unit of Advanced Medicine, Qazvin University of Medical Sciences, Qazvin, Iran

4 Assistant Professor, Pediatric Nephrology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia, and acute renal failure. The purpose of this research is to determine the clinical and laboratory factors predicting the need for dialysis in infants and children with hemolytic uremic syndrome.
Methods: The present analytical cross-sectional study was conducted on children aged 6 months to 13 years with HUS admitted to the Qazvin Children's Hospital in 2020 and 2021. Demographic information and clinical and laboratory findings were recorded. The clinical and laboratory factors of the children who underwent dialysis were statistically compared with those who did not indicate dialysis.
Findings: In a comparison of demographic, clinical, and laboratory indicators in dialysis and non-dialysis patients, mean urine volume, hematocrit level, BUN (Blood urea Nitrogen), creatinine, and GFR (Glomerular filtration rate) were statistically different between the two groups (P < 0.05).
Conclusion: Based on the findings, urine output, hematocrit level, BUN, creatinine, and GFR on the first day and during hospitalization can predict dialysis requirements in HUS patients.

Highlights

Reza Dalirani: Google Scholar, PubMed

Banafsheh Arad: Google Scholar, PubMed 

Keywords

Main Subjects


  1. Bertholet-Thomas A, Ranchin B, King LA, Bacchetta J, Belot A, Gillet Y, et al. Post-diarrheal haemolytic uremic syndrome: when shall we consider it? Which follow-up?. Arch Pediatr 2011; 18(7): 823-30.
  2. Liu Y, Thaker H, Wang C, Xu Z, Dong M. Diagnosis and treatment for Shiga toxin-producing Escherichia coli associated hemolytic uremic syndrome. Toxins (Basel) 2022; 15(1): 10.
  3. Ylinen E, Salmenlinna S, Halkilahti J, Jahnukainen T, Korhonen L, Virkkala T, et al. Hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli in children: incidence, risk factors, and clinical outcome. Pediatr Nephrol 2020; 35(9): 1749-59.
  4. Jenssen GR, Vold L, Hovland E, Bangstad HJ, Nygård K, Bjerre A. Clinical features, therapeutic interventions and long-term aspects of hemolytic-uremic syndrome in Norwegian children: a nationwide retrospective study from 1999-2008. BMC Infect Dis 2016; 16: 285.
  5. Balestracci A, Martin SM, Toledo I, Alvarado C, Wainsztein RE. Laboratory predictors of acute dialysis in hemolytic uremic syndrome. Pediatr Int 2014; 56(2): 234-9.
  6. Talathi S, Barnes M, Aban I, Dimmitt R, Askenazi DJ. Serum transaminases at presentation and association with acute dialysis in children with hemolytic uremic syndrome. Kidney360. 2020; 1(5): 337-42.
  7. Ake JA, Jelacic S, Ciol MA, Watkins SL, Murray KF, Christie DL, et al. Relative nephroprotection during Escherichia coli O157: H7 infections: association with intravenous volume expansion. Pediatrics 2005; 115(6): e673-80.
  8. McKee RS, Schnadower D, Tarr PI, Xie J, Finkelstein Y, Desai N, et al. Predicting hemolytic uremic syndrome and renal replacement therapy in Shiga Toxin–producing Escherichia coli–infected children. Clin Infect Dis 2020; 70(8): 1643-51.
  9. Matsell DG, White CT. An outbreak of diarrhea-associated childhood hemolytic uremic syndrome: the Walkerton epidemic. Kidney Int Suppl 2009; 112: S35-7.
  10. Forzley BR, Clark WF. TTP/HUS and prognosis: the syndrome and the disease (s). Kidney Int Suppl 2009; 112: S59-61.
  11. Wang YH, Huang YC, Chang LY, Kao HT, Lin PY, Huang CG, et al. Clinical characteristics of children with influenza A virus infection requiring hospitalization. J Microbiol Immunol Infect 2003; 36(2): 111-6.
  12. Gao A, Cachat F, Faouzi M, Bardy D, Mosig D, Meyrat BJ, et al. Comparison of the glomerular filtration rate in children by the new revised Schwartz formula and a new generalized formula. Kidney Int 2013; 83(3): 524-30.
  13. Kliegman R, Geme JS, Blum NJ, Tasker RC, Wilson, Schuh AM, Mack CL. Nelson textbook of pediatrics. 22th ed. Amsterdam, Netherlands: Elsevier; 2024.
  14. Lolekha PH, Jaruthunyaluck S, Srisawasdi P. Deproteinization of serum: another best approach to eliminate all forms of bilirubin interference on serum creatinine by the kinetic Jaffe reaction. J Clin Lab Anal 2001; 15(3): 116-21.
  15. Rajs G, Mayer M. Oxidation markedly reduces bilirubin interference in the Jaffe creatinine assay. Clin Chem 1992; 38(12): 2411-3.
  16. Al-Ismaili Z, Palijan A, Zappitelli M. Biomarkers of acute kidney injury in children: discovery, evaluation, and clinical application. Pediatr Nephrol 2011; 26(1): 29-40.
  17. Askenazi D. Evaluation and management of critically ill children with acute kidney injury. Curr Opin Pediatr 2011; 23(2): 201-7.
  18. Walters MD, Matthei IU, Kay R, Dillon MJ, Barratt TM. The polymorphonuclear leucocyte count in childhood haemolytic uraemic syndrome. Pediatr Nephrol 1989; 3(2): 130-4.
  19. Oakes RS, Siegler RL, McReynolds MA, Pysher T, Pavia AT. Predictors of fatality in postdiarrheal hemolytic uremic syndrome. Pediatrics 2006; 117(5): 1656-62.