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Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome.
Arch Pediatr Adolesc Med. 2011 Oct; 165(10):884-9.AP

Abstract

OBJECTIVES

To determine if interventions during the pre-hemolytic uremic syndrome (HUS) diarrhea phase are associated with maintenance of urine output during HUS.

DESIGN

Prospective observational cohort study.

SETTINGS

Eleven pediatric hospitals in the United States and Scotland.

PARTICIPANTS

Children younger than 18 years with diarrhea-associated HUS (hematocrit level <30% with smear evidence of intravascular erythrocyte destruction), thrombocytopenia (platelet count <150 × 10³/mm³), and impaired renal function (serum creatinine concentration > upper limit of reference range for age).

INTERVENTIONS

Intravenous fluid was given within the first 4 days of the onset of diarrhea.

OUTCOME MEASURE

Presence or absence of oligoanuria (urine output ≤ 0.5 mL/kg/h for >1 day).

RESULTS

The overall oligoanuric rate of the 50 participants was 68%, but was 84% among those who received no intravenous fluids in the first 4 days of illness. The relative risk of oligoanuria when fluids were not given in this interval was 1.6 (95% confidence interval, 1.1-2.4; P = .02). Children with oligoanuric HUS were given less total intravenous fluid (r = -0.32; P = .02) and sodium (r = -0.27; P = .05) in the first 4 days of illness than those without oligoanuria. In multivariable analysis, the most significant covariate was volume infused, but volume and sodium strongly covaried.

CONCLUSIONS

Intravenous volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS.

Links

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    Authors+Show Affiliations

    Hickey CA
    Division of Gastroenterology and Nutrition, Department of Pediatrics, Washington University School of Medicine, 1 Children's Place, St Louis, MO 63110, USA.
    Beattie TJ
    No affiliation info available
    Cowieson J
    No affiliation info available
    Miyashita Y
    No affiliation info available
    Strife CF
    No affiliation info available
    Frem JC
    No affiliation info available
    Peterson JM
    No affiliation info available
    Butani L
    No affiliation info available
    Jones DP
    No affiliation info available
    Havens PL
    No affiliation info available
    Patel HP
    No affiliation info available
    Wong CS
    No affiliation info available
    Andreoli SP
    No affiliation info available
    Rothbaum RJ
    No affiliation info available
    Beck AM
    No affiliation info available
    Tarr PI
    No affiliation info available

    MeSH

    Acute Kidney InjuryAdolescentChildChild, PreschoolDiarrheaFemaleFluid TherapyHemolytic-Uremic SyndromeHumansInfantLogistic ModelsMaleMultivariate AnalysisOliguriaProspective StudiesTreatment Outcome

    Pub Type(s)

    Clinical Trial
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    21784993

    Citation

    Hickey, Christina A., et al. "Early Volume Expansion During Diarrhea and Relative Nephroprotection During Subsequent Hemolytic Uremic Syndrome." Archives of Pediatrics & Adolescent Medicine, vol. 165, no. 10, 2011, pp. 884-9.
    Hickey CA, Beattie TJ, Cowieson J, et al. Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome. Arch Pediatr Adolesc Med. 2011;165(10):884-9.
    Hickey, C. A., Beattie, T. J., Cowieson, J., Miyashita, Y., Strife, C. F., Frem, J. C., Peterson, J. M., Butani, L., Jones, D. P., Havens, P. L., Patel, H. P., Wong, C. S., Andreoli, S. P., Rothbaum, R. J., Beck, A. M., & Tarr, P. I. (2011). Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome. Archives of Pediatrics & Adolescent Medicine, 165(10), 884-9. https://doi.org/10.1001/archpediatrics.2011.152
    Hickey CA, et al. Early Volume Expansion During Diarrhea and Relative Nephroprotection During Subsequent Hemolytic Uremic Syndrome. Arch Pediatr Adolesc Med. 2011;165(10):884-9. PubMed PMID: 21784993.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome. AU - Hickey,Christina A, AU - Beattie,T James, AU - Cowieson,Jennifer, AU - Miyashita,Yosuke, AU - Strife,C Frederic, AU - Frem,Juliana C, AU - Peterson,Johann M, AU - Butani,Lavjay, AU - Jones,Deborah P, AU - Havens,Peter L, AU - Patel,Hiren P, AU - Wong,Craig S, AU - Andreoli,Sharon P, AU - Rothbaum,Robert J, AU - Beck,Anne M, AU - Tarr,Phillip I, Y1 - 2011/07/22/ PY - 2011/7/26/entrez PY - 2011/7/26/pubmed PY - 2011/12/13/medline SP - 884 EP - 9 JF - Archives of pediatrics & adolescent medicine JO - Arch Pediatr Adolesc Med VL - 165 IS - 10 N2 - OBJECTIVES: To determine if interventions during the pre-hemolytic uremic syndrome (HUS) diarrhea phase are associated with maintenance of urine output during HUS. DESIGN: Prospective observational cohort study. SETTINGS: Eleven pediatric hospitals in the United States and Scotland. PARTICIPANTS: Children younger than 18 years with diarrhea-associated HUS (hematocrit level <30% with smear evidence of intravascular erythrocyte destruction), thrombocytopenia (platelet count <150 × 10³/mm³), and impaired renal function (serum creatinine concentration > upper limit of reference range for age). INTERVENTIONS: Intravenous fluid was given within the first 4 days of the onset of diarrhea. OUTCOME MEASURE: Presence or absence of oligoanuria (urine output ≤ 0.5 mL/kg/h for >1 day). RESULTS: The overall oligoanuric rate of the 50 participants was 68%, but was 84% among those who received no intravenous fluids in the first 4 days of illness. The relative risk of oligoanuria when fluids were not given in this interval was 1.6 (95% confidence interval, 1.1-2.4; P = .02). Children with oligoanuric HUS were given less total intravenous fluid (r = -0.32; P = .02) and sodium (r = -0.27; P = .05) in the first 4 days of illness than those without oligoanuria. In multivariable analysis, the most significant covariate was volume infused, but volume and sodium strongly covaried. CONCLUSIONS: Intravenous volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS. SN - 1538-3628 UR - https://www.unboundmedicine.com/medline/citation/21784993/full_citation L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/archpediatrics.2011.152 DB - PRIME DP - Unbound Medicine ER -