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13.10.2022 | Original Article

Hyperuricemia: an unrecognized risk factor for kidney-related sequelae in children with hemolytic uremic syndrome

verfasst von: Alejandro Balestracci, Luciana Meni Battaglia, Ismael Toledo, Laura Beaudoin, Sandra Mariel Martin, Nicolás Ariel Grisolía, Ronald J. Hogg

Erschienen in: Pediatric Nephrology | Ausgabe 5/2023

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Abstract

Background

Chronic kidney-related sequelae after STEC-HUS occur in 20–40% of patients. Hyperuricemia (HU) may cause acute and chronic toxicity involving the kidneys. We retrospectively assessed if there was an association between the presence of HU during the acute illness and that of kidney-related sequelae in children with STEC-HUS.

Methods

Children with STEC-HUS who had clinical and laboratory data at 2 years of follow-up were included in this case–control study. Univariate and multivariate analyses were performed between patients with (cases) or without (controls) kidney-related sequelae to identify factors associated with outcomes, including different measures of serum uric acid (sUA) (baseline level, peak, and duration of HU). HU was defined as sUA > 8 mg/dL.

Results

Of 86 patients included, 77.9% had HU. Patients with sequelae (n = 41) had a higher prevalence of HU (41/41 vs. 26/45, p < 0.01), higher baseline leukocyte count, serum creatinine (sCr), and sUA levels as well as lower sodium than controls. During hospitalization, cases also had higher sCr peak, sUA peak and duration of HU, requirement and duration of dialysis, extrarenal complications, and hypertension. By multivariate analysis, after adjusting for length of dialysis, only duration of HU (p = 0.0005; OR 1.7, 95% CI 1.27–2.36) remained as an independent predictor of sequelae, with a best cutoff of 5.5 days (AUC 0.95, specificity 80%, sensitivity 100%).

Conclusions

The presence of HU is a common finding in children with STEC-HUS and its duration during the acute stage was associated with kidney-related sequelae, regardless of the duration of dialysis.

Graphical abstract

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Titel: Hyperuricemia: an unrecognized risk factor for kidney-related sequelae in children with hemolytic uremic syndrome
verfasst von: Alejandro Balestracci
Luciana Meni Battaglia
Ismael Toledo
Laura Beaudoin
Sandra Mariel Martin
Nicolás Ariel Grisolía
Ronald J. Hogg
Publikationsdatum: 13.10.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 5/2023
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-022-05753-5

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Hyperuricemia: an unrecognized risk factor for kidney-related sequelae in children with hemolytic uremic syndrome