Oakes Robert S, Kirkham Justin K, Nelson Raoul D, Siegler Richard L
Division of Nephrology and Hypertension, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
Pediatr Nephrol. 2008 Aug;23(8):1303-8. doi: 10.1007/s00467-008-0799-9. Epub 2008 May 9.
Prior long-term retrospective studies have described renal sequelae in 25-50% of postdiarrheal hemolytic uremic syndrome (HUS) survivors, but the ability to predict the likelihood of chronic renal-related sequelae at the time of hospital discharge is limited. We surveyed 357 children in our HUS registry who survived an acute episode of post diarrheal HUS (D+HUS) and were without end-stage renal disease (ESRD) at the time of hospital discharge. Of the 357 patients surveyed, 159 had at least 1 year (mean 8.75 years) of follow-up. Of these, 90 individuals were identified as having had at least 1 day of oliguria, with 69 individuals having had at least 1 day of anuria. The incidences of renal-related sequelae [proteinuria, low glomerular filtration rate (GFR), and hypertension] were determined among experimental groups based on oliguria and anuria duration. One or more sequelae (e.g. proteinuria, low GFR, hypertension) was seen in 25 (36.2%) of those who had no recorded oliguria and 34 (37.8%) of those with no recorded anuria. The prevalence of chronic sequelae increased markedly in those with more than 5 days of anuria or 10 days of oliguria, with anuria being a better predictor than oliguria of most related sequelae. A particularly high incidence of hypertension was seen in patients with > 10 days of anuria (55.6%) in comparison with those with no anuria (8.9%) [odds ratio (OR) 12.8; 95% confidence interval (CI) 2.9-57.5]. Patients with > 10 days of anuria were also at substantially increased risk for low GFR and proteinuria (OR 35.2; 95% CI 5.1-240.5). These findings may help identify children who need periodic and extended follow-up after hospital discharge.
既往长期回顾性研究表明，25%-50%的腹泻后溶血尿毒综合征（HUS）幸存者会出现肾脏后遗症，但在出院时预测慢性肾脏相关后遗症可能性的能力有限。我们对357名在我们HUS登记处登记的儿童进行了调查，这些儿童均度过了腹泻后HUS（D+HUS）的急性发作期，且出院时未患有终末期肾病（ESRD）。在接受调查的357名患者中，159名患者至少有1年（平均8.75年）的随访时间。其中，90人被确定至少有1天少尿，69人至少有1天无尿。根据少尿和无尿持续时间，在各实验组中确定肾脏相关后遗症（蛋白尿、低肾小球滤过率（GFR）和高血压）的发生率。在无少尿记录的患者中，25人（36.2%）出现了一种或多种后遗症（如蛋白尿、低GFR、高血压）；在无无尿记录的患者中，34人（37.8%）出现了一种或多种后遗症。无尿超过5天或少尿超过10天的患者中，慢性后遗症的患病率显著增加，对于大多数相关后遗症而言，无尿比少尿是更好的预测指标。与无无尿的患者（8.9%）相比，无尿超过10天的患者高血压发生率特别高（55.6%）[比值比（OR）12.8；95%置信区间（CI）2.9-57.5]。无尿超过10天的患者发生低GFR和蛋白尿的风险也大幅增加（OR 35.2；95%CI 5.1-240.5）。这些发现可能有助于识别出院后需要定期和长期随访的儿童。
