Background

A substantial proportion of patients with Escherichia coli-hemolytic uremic syndrome (STEC-HUS) evolve to chronic kidney disease (CKD). The objectives of this study were to evaluate long-term kidney outcomes and to identify CKD predictors.

Methods

In this single-center retrospective study, long-term outcomes of patients were analyzed according to the presence of complete recovery (CR) or CKD at last visit. Then, they were grouped into favorable (CR + CKD1) or poor (CKD2–5) outcome to compare predictors at diagnosis (sex, age, leukocytes, creatinine, hemoglobin, HUS severity score), dialysis duration, and follow-up time between them.

Results

Of 281 patients followed up for a median of 12 years, 139 (49%) had CR, 104 (37%) CKD1, 27 (10%) CKD2–4, and 11 (4%) CKD5. Thirty-eight patients progressed to CKD2–5 after a median of 4.8 years, 7% in the first 5 years, increasing to 8%, 10%, and 14% after 5–10 years, 10–15 years, and > 15 years, respectively. They were younger, had higher baseline hemoglobin and leukocytes, and required longer dialysis and follow-up than those with favorable outcome. By multivariate analysis, days of dialysis and follow-up time remained as independent predictors of poor outcome. The best cutoff for days of dialysis was 10 days. After 5 years, 20% of those dialyzed ≥ 10 days evolved to CKD2–5 versus 1% of those non-dialyzed or dialyzed < 10 days.

Conclusions

Fifty-one percent of patients evolved to CKD after 12 years of follow-up and 14% to CKD2–5. Ten days of dialysis was the best cutoff to recognize outcomes. In some cases, kidney damage was evident after 15 years of surveillance, highlighting the need for follow-up until adulthood in all STEC-HUS patients.

Graphical Abstract

背景

很大一部分大肠杆菌溶血性尿毒症综合征 (STEC-HUS) 患者会发展为慢性肾病 (CKD)。本研究的目的是评估长期肾脏结局并确定 CKD 预测因子。

方法

在这项单中心回顾性研究中，根据上次就诊时是否存在完全康复（CR）或 CKD 来分析患者的长期结局。然后，将它们分为有利（CR + CKD1）或不良（CKD2-5）结果，以比较诊断时的预测因素（性别、年龄、白细胞、肌酐、血红蛋白、HUS 严重程度评分）、透析持续时间和随访时间。他们。

结果

在 281 名患者中，随访时间中位数为 12 年，其中 139 名患者 (49%) 获得 CR，104 名患者 (37%) 获得 CKD1，27 名患者 (10%) 获得 CKD2-4，11 名患者 (4%) 获得 CKD5。38 名患者在中位 4.8 年后进展为 CKD2-5，前 5 年为 7%，5-10 年、10-15 年和 > 15 年后增加至 8%、10% 和 14% ， 分别。与那些结果良好的人相比，他们更年轻，基线血红蛋白和白细胞更高，并且需要更长的透析和随访时间。通过多变量分析，透析天数和随访时间仍然是不良结果的独立预测因素。透析天数的最佳截止时间是 10 天。5 年后，透析 ≥ 10 天的患者中有 20% 发展为 CKD2-5，而未透析或透析 < 10 天的患者中只有 1% 发展为 CKD2-5。

结论

12 年随访后，51% 的患者发展为 CKD，14% 发展为 CKD2-5。透析十天是识别结果的最佳截止时间。在某些情况下，经过 15 年的监测后，肾脏损伤很明显，这突出表明需要对所有 STEC-HUS 患者进行随访直至成年。

图形概要