Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome

Christina A. Hickey, T. James Beattie, Jennifer Cowieson, Yosuke Miyashita, C. Frederic Strife, Juliana C. Frem, Johann M Peterson, Lavjay Butani, Deborah P. Jones, Peter L. Havens, Hiren P. Patel, Craig S. Wong, Sharon P. Andreoli, Robert J. Rothbaum, Anne M. Beck, Phillip I. Tarr

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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-associatedHUS(hematocrit level≲λτ∀30%with smear evidence of intravascular erythrocyte destruction), thrombocytopenia (platelet count ≲λτ ∀150χ10 3/mm 3), and impaired renal function (serum creatinine concentration≲γτ∀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.

Original languageEnglish (US)
Pages (from-to)884-889
Number of pages6
JournalArchives of Pediatrics and Adolescent Medicine
Volume165
Issue number10
DOIs
StatePublished - Oct 2011

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    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 and Adolescent Medicine, 165(10), 884-889. https://doi.org/10.1001/archpediatrics.2011.152