Balestracci Alejandro, Meni Battaglia Luciana, Toledo Ismael, Beaudoin Laura, Martin Sandra Mariel, Grisolía Nicolás Ariel, Hogg Ronald J
Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Autonomous City of Buenos Aires, CP, Argentina.
Department of Medicine, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Autonomous City of Buenos Aires, Argentina.
Pediatr Nephrol. 2023 May;38(5):1547-1557. doi: 10.1007/s00467-022-05753-5. Epub 2022 Oct 13.
Chronic kidney-related sequelae after STEC-HUS occur in 20-40% of patients. Hyperuricemia (HU) may cause acute and chronic toxicity involving the kidneys. We retrospectively assessed if there was an association between the presence of HU during the acute illness and that of kidney-related sequelae in children with STEC-HUS.
Children with STEC-HUS who had clinical and laboratory data at 2 years of follow-up were included in this case-control study. Univariate and multivariate analyses were performed between patients with (cases) or without (controls) kidney-related sequelae to identify factors associated with outcomes, including different measures of serum uric acid (sUA) (baseline level, peak, and duration of HU). HU was defined as sUA > 8 mg/dL.
Of 86 patients included, 77.9% had HU. Patients with sequelae (n = 41) had a higher prevalence of HU (41/41 vs. 26/45, p < 0.01), higher baseline leukocyte count, serum creatinine (sCr), and sUA levels as well as lower sodium than controls. During hospitalization, cases also had higher sCr peak, sUA peak and duration of HU, requirement and duration of dialysis, extrarenal complications, and hypertension. By multivariate analysis, after adjusting for length of dialysis, only duration of HU (p = 0.0005; OR 1.7, 95% CI 1.27-2.36) remained as an independent predictor of sequelae, with a best cutoff of 5.5 days (AUC 0.95, specificity 80%, sensitivity 100%).
The presence of HU is a common finding in children with STEC-HUS and its duration during the acute stage was associated with kidney-related sequelae, regardless of the duration of dialysis. A higher resolution version of the Graphical abstract is available as Supplementary Information.
产志贺毒素大肠杆菌相关性溶血尿毒综合征（STEC-HUS）后的慢性肾脏相关后遗症在20%至40%的患者中出现。高尿酸血症（HU）可能导致涉及肾脏的急性和慢性毒性。我们进行了回顾性评估，以确定STEC-HUS患儿急性疾病期间高尿酸血症的存在与肾脏相关后遗症之间是否存在关联。
本病例对照研究纳入了在随访2年时有临床和实验室数据的STEC-HUS患儿。对有（病例组）或无（对照组）肾脏相关后遗症的患者进行单因素和多因素分析，以确定与结局相关的因素，包括血清尿酸（sUA）的不同测量指标（基线水平、峰值和高尿酸血症持续时间）。高尿酸血症定义为sUA＞8mg/dL。
在纳入的86例患者中，77.9%有高尿酸血症。有后遗症的患者（n = 41）高尿酸血症的患病率更高（41/41对26/45，p＜0.01），基线白细胞计数、血清肌酐（sCr）和sUA水平更高，而钠水平低于对照组。住院期间，病例组的sCr峰值、sUA峰值和高尿酸血症持续时间、透析需求和持续时间、肾外并发症及高血压也更高。通过多因素分析，在调整透析时间后，只有高尿酸血症持续时间（p = 0.0005；OR 1.7，95%CI 1.27 - 2.36）仍然是后遗症的独立预测因素，最佳截断值为5.5天（AUC 0.95，特异性80%，敏感性100%）。
高尿酸血症在STEC-HUS患儿中很常见，其急性期的持续时间与肾脏相关后遗症有关，与透析时间无关。更高分辨率的图形摘要可作为补充信息获取。
