溶血性尿毒症综合征：明确长期随访的必要性。

Hemolytic uremic syndrome: defining the need for long-term follow-up.

作者信息

Small G, Watson A R, Evans J H, Gallagher J

机构信息

Children and Young People's Renal Unit, City Hospital, NHS Trust, Nottingham, UK.

出版信息

Clin Nephrol. 1999 Dec;52(6):352-6.

PMID:10604642

Abstract

BACKGROUND

Diarrhea-associated (D+) hemolytic uremic syndrome (HUS) is a common cause of acute renal failure in children. Progressive renal insufficiency has been documented on prolonged follow-up of selected patients. However, it is uncertain whether all children recovering from varying degrees of HUS require long-term follow-up.

PATIENTS AND METHODS

We reviewed the outcome of 114 patients with D+ HUS presenting to a regional pediatric unit between January 1986 and December 1996. Yearly clinical review post illness included measurement of blood pressure and urinalysis for proteinuria with planned GFR assessments by 51Cr EDTA slope clearance at 1 and 5 years.

RESULTS

Treatment of the HUS was conservative in 27%, by peritoneal dialysis in 62%, hemodialysis in 4% and both peritoneal and hemodialysis in 7%. Ninety-two patients were assessed at 1 year - of these, 1 remained on chronic peritoneal dialysis, 5 (5%) had moderate to severe chronic renal failure (CRF) (GFR 25 - 50 ml/min/1.73 m2), 20 (22%) had mild CRF (GFR 50-80) and 66 (72%) had normal renal function (> or =80 ml/min/1.73 m2). Forty patients have had GFRs performed at 1 and 5 years. Of the 28 patients with a normal GFR at 1 year, 3 deteriorated into mild CRF at 5 years. One patient has a single kidney and one had significant proteinuria at 1 year, factors which would have led to long-term follow-up. There was a negative correlation between number of days of dialysis and GFR at 1 year with a Pearson's correlation coefficient of -0.453 (p<0.01).

CONCLUSION

We conclude that renal function at I year following HUS cannot be predicted with any certainty from the initial illness and should be formally assessed. However, renal function was within normal limits and remained stable between 1 and 5 years following HUS in most children. The results suggest that longer-term follow-up can probably be restricted to those with proteinuria, hypertension, abnormal ultrasound and/or impaired GFR at 1 year.

摘要

背景

腹泻相关性（D+）溶血性尿毒症综合征（HUS）是儿童急性肾衰竭的常见病因。对部分患者进行长期随访发现存在进行性肾功能不全。然而，尚不确定所有从不同程度的HUS中恢复的儿童是否都需要长期随访。

患者与方法

我们回顾了1986年1月至1996年12月间在某地区儿科病房就诊的114例D+ HUS患者的预后情况。病后每年进行临床复查，包括测量血压、尿常规检测蛋白尿，并计划在1年和5年时通过51Cr EDTA斜率清除率评估肾小球滤过率（GFR）。

结果

27%的HUS患者采用保守治疗，62%采用腹膜透析，4%采用血液透析，7%采用腹膜透析和血液透析联合治疗。92例患者在1年时接受了评估，其中1例仍在进行慢性腹膜透析，5例（5%）患有中度至重度慢性肾衰竭（CRF）（GFR 25 - 50 ml/min/1.73 m2），20例（22%）患有轻度CRF（GFR 50 - 80），66例（72%）肾功能正常（≥80 ml/min/1.73 m2）。40例患者在1年和5年时进行了GFR检测。在1年时GFR正常的28例患者中，3例在5年时恶化为轻度CRF。1例患者为单肾，1例在1年时存在大量蛋白尿，这些因素本会导致长期随访。透析天数与1年时的GFR呈负相关，Pearson相关系数为 -0.453（p<0.01）。