Albuminuria and estimated GFR 5 years after Escherichia coli O157 hemolytic uremic syndrome: an update

Am J Kidney Dis. 2008 Mar;51(3):435-44. doi: 10.1053/j.ajkd.2007.10.042.


Background: Knowledge of the long-term prognosis of patients with diarrhea-associated hemolytic uremic syndrome (HUS) is important for patient counseling and follow-up. Estimates in the literature are highly variable, and previous studies did not use a healthy control group to establish outcomes attributable to HUS.

Study design: Prospective cohort study.

Setting & participants: 19 children who recovered from HUS after contamination of their municipal water supply by Escherichia coli O157:H7.

Predictor: Outcomes of children who recovered from HUS were compared with a control group of 64 children who were healthy at the time of the outbreak. Both groups were similar in their demographics and follow-up testing.

Outcomes & measurements: Proteinuria, blood pressure, glomerular filtration rate (GFR) estimated by using serum creatinine or cystatin C level, and biochemical measures 5 years after the outbreak.

Results: More children who recovered from HUS showed microalbuminuria than controls (20% versus 3%; relative risk, 6.0; 95% confidence interval, 1.1 to 32.8). There were no differences between groups in blood pressure or GFR when estimated by using serum creatinine level. GFR estimated by using cystatin C level was lower after HUS compared with controls (100 versus 110 mL/min/1.73 m(2); P = 0.02), but no child had a GFR less than 80 mL/min/1.73 m(2). Other results, including fasting glucose, albumin, and C-reactive protein levels, did not differ between groups.

Limitations: Although the homogenous nature of this outbreak is a strength, long-term results may generalize less well to patients with other strains of toxigenic E coli or in other settings.

Conclusions: The prognosis of patients with HUS in this cohort was better than in other studies. Ongoing follow-up will clarify the clinical relevance of microalbuminuria and mild decreases in GFR 5 years after HUS recovery.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Albuminuria / epidemiology*
  • Child
  • Child, Preschool
  • Disease Outbreaks
  • Escherichia coli O157*
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate*
  • Hemolytic-Uremic Syndrome / complications*
  • Hemolytic-Uremic Syndrome / etiology
  • Hemolytic-Uremic Syndrome / microbiology
  • Humans
  • Infant
  • Kidney Function Tests
  • Male
  • Ontario
  • Prognosis
  • Prospective Studies
  • Water Microbiology
  • Water Supply