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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
MeSH
Pub Type(s)
Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
Language
eng
PubMed ID
21784993
Clinical Trial Links
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 -
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