SAT-160 POSTDIARRHEAL HEMOLYTIC UREMIC SYNDROME IN CHILDREN: AN 11-YEAR EGYPTIAN EXPERIENCE

Abstract

Hemolytic-uremic syndrome (HUS) is a leading cause of childhood acute kidney injury(AKI) worldwide with its postdiarrheal (D+HUS) form being the commonest with scarce data about its epidemiology available from developing countries. This study aims to reveal the characterization of D+ HUS in Egyptian children. This is a retrospective study of all children with D+HUS admitted to a tertiary pediatric hospital in delta region of Egypt between 2007 and 2017.Study included epidemiological, clinical, laboratory data, management details, and outcomes. A cohort of 132 children aged 4months-12 years,53% females was analyzed. Yearly incidence peaked in 2017 and spring showed the highest peak. All cases had a diarrheal prodrome that was bloody in 110 cases. Edema and decreased urine output were the most frequent presentations (50.3% and 42.4% respectively). Escherichia coli was detected in 56 cases . Patients' laboratory results are presented in Table I. A positive correlation between serum creatinine and lactate dehydrogenase(LDH) and negative correlation between serum creatinine and corrected reticulocytic count were reported.Dialysis was performed in 102 cases. Eight patients died during acute illness mainly due to volume overload and sepsis while 5 patients experienced long-term sequels. Univariate analysis showed that anuria duration, short duration between diarrheal illness and development of AKI, leucocytic count above 20x109cells/L (P ≤0.001), platelet count below 30 x109cells/L (P= 0.02), high LDH levels (P= 0.02) and hematocrit above 30% (P= 0.0001), short interval between diarrhea and AKI presentation (P= 0.001), need for dialysis (P= 0.03) and neurological involvement (P ≤0.001) were associated with unfavorable outcomes ,however no significant difference was found as a result of logistic regression when we tested significant factors of univariate analysis. While age of patients, sex, use of antibiotics during diarrheal prodrome and bloody stools were not associated with poor outcomes.Tabled 1Table I: Laboratory data of studied patients.ParameterRangeMean ± SDCreatinine (mg/dl) (at presentation)2.8-126.52±1.95Glomerular filtration rate (ml/min/1.73m2)6.8-35.310.43±4.3Haemoglobin (g/dl) (lowest)3.5-8.96.1±1.1White blood cells x109 cells/L (peak)4.6-4312.25±7.13Platelet x109 cells/L (lowest)14-11166.46±23.53Complement 3 (at presentation) (mg/dl)84-192126.8±22.29Serum bilirubin (unconjugated)(mg/dl)2.6-8.44.5±1.92Corrected reticulocytic count (at presentation) (%)0.4-123.08±1.6Lactate dehydrogenase (83 cases only) (at presentation) (Unit/liter)1061-88103322.94±2.57PH (at presentation)6.8-7.387.15±0.13HCO3 (at presentation) (mEq/L)2.8-1812.06±2.57Calcium (at presentation) (mg/dl)5.3-10.58.48±1.19Phosphorus (at presentation) (mg/dl)3-146.78±1.73Sodium (at presentation) (mEq/L)120-152130.84±6.89Potassium (at presentation) (mEq/L)3.2-8.25.35±0.78Albumin (at presentation) (g/dl)3.4-4.84.1±0.31 Open table in a new tab This is the first report with an insight into epidemiology of D+HUS in Egyptian children. Incidence of D+HUSis increasing in our country due to increased awareness of the disease and the poor public health measures. Anuria duration, leucocytic count and neurological involvement are predictors of poor outcome in the current work as previously reported while LDH is presented as a new predictor for disease severity and outcome.