Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome. Arch Pediatr Adolesc Med 2011 Oct;165(10):884-9
Date
07/26/2011Pubmed ID
21784993Pubmed Central ID
PMC4064458DOI
10.1001/archpediatrics.2011.152Scopus ID
2-s2.0-80053405654 (requires institutional sign-in at Scopus site) 108 CitationsAbstract
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.
Author List
Hickey CA, Beattie TJ, Cowieson J, Miyashita Y, Strife CF, Frem JC, Peterson JM, Butani L, Jones DP, Havens PL, Patel HP, Wong CS, Andreoli SP, Rothbaum RJ, Beck AM, Tarr PIMESH terms used to index this publication - Major topics in bold
Acute Kidney InjuryAdolescent
Child
Child, Preschool
Diarrhea
Female
Fluid Therapy
Hemolytic-Uremic Syndrome
Humans
Infant
Logistic Models
Male
Multivariate Analysis
Oliguria
Prospective Studies
Treatment Outcome
