Clinical characteristics and long-term outcome of diarrhea-associated hemolytic uremic syndrome: a single center experience

Clin Exp Nephrol. 2017 Oct;21(5):889-894. doi: 10.1007/s10157-016-1376-3. Epub 2017 Jan 10.


Objectives: To clarify the clinical characteristics and long-term outcomes of patients with diarrhea-associated hemolytic uremic syndrome (D + HUS) with a particular focus on time course.

Methods: We retrospectively analyzed the medical records of 61 patients with D + HUS who were admitted to Kobe University Hospital between 1995 and 2015. The onset of D + HUS was defined as day 1 of diarrhea.

Results: The age of onset was 4.1 (1.5-13.4) years, and the period between onset and diagnosis of D + HUS was 5 (3-18) days. The platelet count was lowest on day 7 (4-24), and the lactase dehydrogenase level was maximal on day 8 (4-25). Twenty-three patients required dialysis for 13 (2-37) days, starting at day 5-9. Seventeen patients showed central nervous system (CNS) symptoms at day 4-18. They were followed up for 3.7 (0-18.4) years. At the final follow-up, estimated glomerular filtration rate was 113.7 (57.9-159.9) ml/min/1.73 m2 with five patients having chronic kidney disease. Three patients developed CNS sequelae. The time to diagnosis was significantly shorter in the group of patients receiving dialysis than without dialysis (p = 0.018) and in the group with CNS complications than without (p = 0.013).

Conclusion: CNS complications were often apparent after blood examination results improved. Moreover, a shorter period between the onset of diarrhea and a diagnosis of D + HUS indicated a more severe clinical course or long-term sequelae, and it should be considered as a risk factor for poor prognosis.

Keywords: Central nervous system complication; Dialysis; Hemolytic uremic syndrome; Kidney dysfunction.

MeSH terms

  • Adolescent
  • Central Nervous System Diseases / etiology
  • Child
  • Child, Preschool
  • Diarrhea / complications*
  • Diarrhea / diagnosis
  • Disease Progression
  • Female
  • Glomerular Filtration Rate
  • Hemolytic-Uremic Syndrome / diagnosis
  • Hemolytic-Uremic Syndrome / etiology*
  • Hemolytic-Uremic Syndrome / physiopathology
  • Hemolytic-Uremic Syndrome / therapy
  • Hospitals, University
  • Humans
  • Infant
  • Japan
  • Kidney / physiopathology*
  • Male
  • Medical Records
  • Prognosis
  • Renal Dialysis
  • Retrospective Studies
  • Time Factors