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. 2024 Jun;39(6):1901-1907.
doi: 10.1007/s00467-023-06276-3. Epub 2024 Jan 19.

Volume expansion mitigates Shiga toxin-producing E. coli-hemolytic uremic syndrome in children

Johannes Böckenhauer  1 , Raphael Schild  1 , Markus J Kemper  2 , Thomas Henne  1 , Marie V Stein  1 , Jun Oh  1 , Sebastian Loos  3
Affiliations

Volume expansion mitigates Shiga toxin-producing E. coli-hemolytic uremic syndrome in children

Johannes Böckenhauer et al. Pediatr Nephrol. 2024 Jun.

Abstract

Background: Shiga toxin-producing E. coli-hemolytic uremic syndrome (STEC-HUS) is associated with high morbidity and relevant mortality. Previous small studies showed that volume expansion could improve the course and outcome of STEC-HUS. The aim of this single-center study was to evaluate the effect of volume expansion on the clinical course and outcome in STEC-HUS.

Methods: Data of pediatric patients with STEC-HUS were analyzed retrospectively. Course and outcome of patients treated with volume expansion (VE) from 2019 to 2022 (n = 38) were compared to historical controls (HC) from 2009 to 2018 (n = 111).

Results: Patients in the VE group had a significant relative median weight gain compared to HC (7.8% (3.4-11.3) vs. 1.2% (- 0.7-3.9), p < 0.0001) 48 h after admission. The need for dialysis was not reduced by VE (VE 21/38 (55.3%) vs. HC 64/111 (57.7%), p = 0.8). However, central nervous system involvement (impairment of consciousness, seizures, focal neurological deficits, and/or visual disturbances) was significantly reduced (VE 6/38 (15.8%) vs. HC 38/111 (34.2%), p = 0.039). None of the patients in the VE group died or developed chronic kidney disease (CKD) stage 5, whereas in the HC group, three patients died and three patients had CKD stage 5 at discharge.

Conclusions: This study suggests that volume expansion may be associated with the mitigation of the acute course of STEC-HUS, especially severe neurological involvement and the development of CKD. Prospective trials should lead to standardized protocols for volume expansion in children with STEC-HUS.

Keywords: EHEC; HUS; Hyperhydration; Outcome; STEC; Volume expansion.

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Conflict of interest statement

The authors declare no competing interests.

Figures

None
A higher resolution version of the Graphical abstract is available as Supplementary information
Fig. 1
Fig. 1
Development of body weight after 48 h in historic controls (HC) and patients treated with volume expansion (VE). Individual values and median are shown
See this image and copyright information in PMC

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