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Pediatr Nephrol. 2017 Jun;32(6):1005-1011. doi: 10.1007/s00467-016-3574-3. Epub 2017 Feb 8.

Endothelial dysfunction during long-term follow-up in children with STEC hemolytic-uremic syndrome.

Author information

1
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. kreuzer.martin@mh-hannover.de.
2
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
3
University Children's Hospital, University of Rostock, Rostock, Germany.

Abstract

BACKGROUND:

Shiga-toxin-producing Escherichia coli (STEC)-associated hemolytic-uremic syndrome (HUS) is a major cause of acute kidney injury (AKI), especially in children. Its long-term outcome with respect to endothelial damage remains largely elusive.

METHODS:

This was a cross-sectional study in 26 children who had suffered from STEC-HUS in the past and achieved a complete recovery of renal function (eGFR >90 ml/min/1.73 m2). Skin microcirculation after local heating was assessed by laser Doppler fluximetry, carotid-femoral pulse wave velocity (PWV), carotid intima media thickness (cIMT), 24-h ambulatory blood pressure, and angiopoietin (Ang) 1 and 2 serum levels after a median follow-up period of 6.1 years. The results were compared to those of healthy controls.

RESULTS:

All patients were normotensive, mean eGFR was 102 (range 91-154) ml/min/1.73 m2, and 13 of the 26 patients showed albuminuria. Endothelial dysfunction was present in 13 patients, and the mean serum Ang2/Ang1 ratio was increased compared to healthy children (each p < 0.05). In contrast, mean values for PWV and cIMT in the patients did not differ from those of the controls. Endothelial dysfunction was significantly associated with younger age at STEC-HUS manifestation, time after HUS, and presence of albuminuria.

CONCLUSION:

The results of this study highlight the need for long-term follow-up of STEC-HUS patients even after complete recovery of eGFR and lack of hypertension with respect to microvascular damage.

KEYWORDS:

Arterial stiffness; Endothelial dysfunction; Late-time renal sequelae; STEC hemolytic uremic syndrome; Skin microcirculation

PMID:
28180952
DOI:
10.1007/s00467-016-3574-3
[Indexed for MEDLINE]

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