Possible other causative risk factors in patients with chronic renal disease who had a history of hemolytic uremic syndrome

Abstract

To the Editor: Sharma et al.1 reported the increased prevalence of chronic kidney disease in patients with hemolytic uremic syndrome (HUS) who had a positive history of diarrhea. The study sample included a retrospective cohort matched with healthy subjects without any chronic disease, including diabetes and hypertension. Of the 30 HUS patients, 12 were less than 12 years old, 5 were between 12 and 18 years old, and 6 were older than 18 years. According to the results of this study, there is a high risk of increase in albumin/creatinine ratio in HUS patients when compared with healthy subjects. However, with regard to the study setting, data about the history of HUS patients regarding chronic diseases such as type 1 diabetes mellitus, tubulointerstitial disease, and so on that could cause microalbuminuria and increased albumin/creatinine ratio was not detailed by the authors. Rachmani et al.2 reported that increased albumin excretion rates, even in the upper normal range, could increase the progression of chronic kidney disease in diabetic patients. Onset of type 1 diabetes mellitus before the age of 20 is another established risk factor for increased cumulative prevalence of chronic kidney disease.3 Acute interstitial nephritis is also associated with mild proteinuria in children.4 Therefore, data about patients’ history should be detailed in the article, including the diseases causing proteinuria as an exclusion criterion.