Pediatric nephrology (Berlin, Germany) · 2026
Impact of early volume expansion on severe long-term kidney sequelae in children with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome.
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Coccia Paula A, Alconcher Laura F, Balestracci Alejandro, Spizzirri Ana Paula, Chervo Laura A Garcia, Principi Iliana, Vazquez Aida, Ramirez Flavia B, Isern Elsa M, Saurit Mariana, Ramirez Gimena, Gutierrez Maria Graciela Perez Y, Giordano Marta I, Aralde Adriana, Selva Veronica S, Quijada Nahir E, Montero Jorge, Exeni Andrea M, Bronfen Sabrina, Escalante Romina S, Bettendorff María Carolina, Ripeau Diego B, Massó Diana, Ratto Viviana M, Cordoba Cecilia, Ojeda Jose
Аннотация
BACKGROUND: Early fluid management may influence disease severity and long-term kidney outcomes in children with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS). We evaluated the association between early volume expansion and severe long-term kidney sequelae.
METHODS: We conducted a multicenter retrospective cohort study including children with STEC-HUS and severe acute kidney injury, defined by the need for dialysis for at least 48 h. Kidney outcome at follow-up was classified according to estimated glomerular filtration rate (GFR) as normal kidney function or chronic kidney disease stage 1 versus chronic kidney disease stages 2-5.
RESULTS: A total of 232 children were included. Median age was 2.34 years (interquartile range 1.6-4). At the end of follow-up (median 4.8 years, interquartile range 3.2-6.6), 72 patients (31%) had kidney sequelae corresponding to chronic kidney disease stages 2-5. Early volume expansion was performed in 102 patients (44%). These patients required dialysis for a shorter duration, had higher estimated GFR at follow-up, and less frequently developed chronic kidney disease stages 2-5. Lack of early volume expansion was independently associated with higher odds of kidney sequelae (odds ratio 2.46, 95% confidence interval 1.25-5.03), as was longer dialysis duration (odds ratio 1.10 per day, 95% confidence interval 1.05-1.15). Estimated GFR at follow-up was inversely correlated with dialysis duration; this association was not evident in patients who received early volume expansion but remained significant in those who did not.
CONCLUSIONS: Early volume expansion and shorter dialysis duration were associated with long-term improved kidney outcomes.
METHODS: We conducted a multicenter retrospective cohort study including children with STEC-HUS and severe acute kidney injury, defined by the need for dialysis for at least 48 h. Kidney outcome at follow-up was classified according to estimated glomerular filtration rate (GFR) as normal kidney function or chronic kidney disease stage 1 versus chronic kidney disease stages 2-5.
RESULTS: A total of 232 children were included. Median age was 2.34 years (interquartile range 1.6-4). At the end of follow-up (median 4.8 years, interquartile range 3.2-6.6), 72 patients (31%) had kidney sequelae corresponding to chronic kidney disease stages 2-5. Early volume expansion was performed in 102 patients (44%). These patients required dialysis for a shorter duration, had higher estimated GFR at follow-up, and less frequently developed chronic kidney disease stages 2-5. Lack of early volume expansion was independently associated with higher odds of kidney sequelae (odds ratio 2.46, 95% confidence interval 1.25-5.03), as was longer dialysis duration (odds ratio 1.10 per day, 95% confidence interval 1.05-1.15). Estimated GFR at follow-up was inversely correlated with dialysis duration; this association was not evident in patients who received early volume expansion but remained significant in those who did not.
CONCLUSIONS: Early volume expansion and shorter dialysis duration were associated with long-term improved kidney outcomes.