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Arch Pediatr Adolesc Med. 2011 Oct;165(10):884-9. doi: 10.1001/archpediatrics.2011.152. Epub 2011 Jul 22.

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

Author information

1
Division of Gastroenterology and Nutrition, Department of Pediatrics, Washington University School of Medicine, 1 Children's Place, St Louis, MO 63110, USA.

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.

PMID:
21784993
PMCID:
PMC4064458
DOI:
10.1001/archpediatrics.2011.152
[Indexed for MEDLINE]
Free PMC Article
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