Kreuzer Martin, Sollmann Laura, Ruben Stephan, Leifheit-Nestler Maren, Fischer Dagmar-Christiane, Pape Lars, Haffner Dieter
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
University Children's Hospital, University of Rostock, Rostock, Germany.
Pediatr Nephrol. 2017 Jun;32(6):1005-1011. doi: 10.1007/s00467-016-3574-3. Epub 2017 Feb 8.
Shiga-toxin-producing Escherichia coli (STEC)-associated hemolytic-uremic syndrome (HUS) is a major cause of acute kidney injury (AKI), especially in children. Its long-term outcome with respect to endothelial damage remains largely elusive.
This was a cross-sectional study in 26 children who had suffered from STEC-HUS in the past and achieved a complete recovery of renal function (eGFR >90 ml/min/1.73 m). Skin microcirculation after local heating was assessed by laser Doppler fluximetry, carotid-femoral pulse wave velocity (PWV), carotid intima media thickness (cIMT), 24-h ambulatory blood pressure, and angiopoietin (Ang) 1 and 2 serum levels after a median follow-up period of 6.1 years. The results were compared to those of healthy controls.
All patients were normotensive, mean eGFR was 102 (range 91-154) ml/min/1.73 m, and 13 of the 26 patients showed albuminuria. Endothelial dysfunction was present in 13 patients, and the mean serum Ang2/Ang1 ratio was increased compared to healthy children (each p < 0.05). In contrast, mean values for PWV and cIMT in the patients did not differ from those of the controls. Endothelial dysfunction was significantly associated with younger age at STEC-HUS manifestation, time after HUS, and presence of albuminuria.
The results of this study highlight the need for long-term follow-up of STEC-HUS patients even after complete recovery of eGFR and lack of hypertension with respect to microvascular damage.
产志贺毒素大肠杆菌（STEC）相关的溶血性尿毒症综合征（HUS）是急性肾损伤（AKI）的主要原因，尤其是在儿童中。其在内皮损伤方面的长期预后仍 largely 难以捉摸。
这是一项对 26 名既往患有 STEC-HUS 且肾功能完全恢复（估算肾小球滤过率[eGFR]>90 ml/min/1.73 m²）的儿童进行的横断面研究。在中位随访期 6.1 年后，通过激光多普勒血流仪评估局部加热后的皮肤微循环、颈股脉搏波速度（PWV）、颈动脉内膜中层厚度（cIMT）、24 小时动态血压以及血管生成素（Ang）1 和 2 的血清水平。将结果与健康对照者的结果进行比较。
所有患者血压正常，平均 eGFR 为 102（范围 91 - 154）ml/min/1.73 m²，26 名患者中有 13 名出现蛋白尿。13 名患者存在内皮功能障碍，与健康儿童相比，平均血清 Ang2/Ang1 比值升高（均 p < 0.05）。相比之下，患者的 PWV 和 cIMT 平均值与对照组无差异。内皮功能障碍与 STEC-HUS 表现时的年龄较小、HUS 后的时间以及蛋白尿的存在显著相关。
本研究结果强调，即使在 eGFR 完全恢复且无高血压的情况下，对于 STEC-HUS 患者的微血管损伤仍需要进行长期随访。
