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Kidney sequelae in 281 Shiga toxin–producing Escherichia coli-hemolytic uremic syndrome patients after a median follow-up of 12 years

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Abstract

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.

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Data Availability

The data are available from the corresponding author on reasonable request

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Acknowledgements

The authors gratefully acknowledge the assistance of Alejandro Balestracci, MD Ph.D., for his valuable observations during the preparation of this paper and María Eugenia Elorza, Ph.D. in Economics, for the statistical analysis done at Universidad Nacional del Sur.

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Authors and Affiliations

  1. Pediatric Nephrology Unit, Hospital Interzonal General Dr. José Penna, Bahía Blanca, Buenos Aires, Argentina

    Laura F. Alconcher, Lucas I. Lucarelli & Sabrina Bronfen

  2. Instituto de Matemática de Bahía Blanca (INMABB), Departamento de Matemática, Universidad Nacional del Sur-CONICET, Bahía Blanca, Argentina

    Fernanda Villarreal

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  1. Laura F. Alconcher
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Correspondence to Laura F. Alconcher.

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This is an observational, retrospective study. The Review Boards and Ethics Committees approved this study. The requirement to obtain informed consent was waived by the institutional review boards.

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Alconcher, L.F., Lucarelli, L.I., Bronfen, S. et al. Kidney sequelae in 281 Shiga toxin–producing Escherichia coli-hemolytic uremic syndrome patients after a median follow-up of 12 years. Pediatr Nephrol 39, 1221–1228 (2024). https://doi.org/10.1007/s00467-023-06183-7

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