Impact of the COVID-19 pandemic on pediatric hemolytic uremic syndrome: Epidemiology, complications, and outcomes.

BACKGROUND

Hemolytic-uremic syndrome (HUS) is a thrombotic microangiopathy that is most commonly caused by infection with Shiga toxin-producing Escherichia coli (STEC-HUS). Atypical HUS (aHUS) is associated with inappropriate activation of the alternative complement pathway caused by infections, including SARS-CoV-2, malignancies, medications, or other triggering factors in genetically predisposed individuals.

OBJECTIVES

Assessment of the impact of the COVID-19 pandemic on epidemiology, course, complications, and outcome of HUS in children in a single tertiary nephrological center in Poland.

MATERIAL AND

METHODS

It is a retrospective study, in which a total number of 74 pediatric patients with HUS were analyzed, including 16 cases in 5-year period before the outbreak of the COVID-19 pandemic (HUS-5) and 58 cases in 5-year period after the outbreak of the pandemic (HUS+5).

RESULTS

A more than 3.6-fold increase in HUS cases and a 7-fold higher incidence of STEC-HUS were reported in the HUS+5 population. Strokes and persistent neurological complications were observed only in this group. 91.9% of patients presented with abnormal renal ultrasound (USG) findings at admission, and these findings improved significantly more frequently in the HUS-5 (68.75% vs 25.9%, p = 0.002) group. Mortality did not differ significantly between the 2 analyzed groups and was 6.8% for the entire population.

CONCLUSIONS

The COVID-19 pandemic has had a significant impact on the incidence of HUS in the pediatric population. SARS-CoV-2 infection most markedly increases the risk of neurological complications but does not affect overall mortality.