Hemolytic-uremic syndrome in adolescents
R. L. Siegler, A. T. Pavia and J. B. Cook
Division of Nephrology, University of Utah School of Medicine, Salt Lake City, USA.
OBJECTIVE: To compare the epidemiological characteristics, clinical
features, and outcome of adolescents with hemolytic-uremic syndrome (HUS)
with those of children with HUS. DESIGN: A retrospective descriptive study
using data stored in the computerized Utah HUS registry. SETTING: The HUS
registry contains data on postdiarrheal and nondiarrheal HUS cases since
1970 in which the patients were younger than 18 years of age at the time of
diagnosis and includes virtually all Utah cases as well as those referred
from surrounding states. PATIENTS: Seventeen adolescents (age, 12-17 years)
and 276 younger patients from September 30, 1970, through December 5, 1993,
who met the diagnostic criteria for HUS. MAIN OUTCOME MEASURES: Age, sex,
seasonality, prodromal features (eg, antecedent diarrhea), laboratory
values, hospital course, outcome, and chronic sequelae. RESULTS: The 17
adolescent patients, who composed 5.8% of the study population, experienced
a course of the disease that was similar to that of the younger patients.
Diarrhea preceded HUS in approximately 90% of the patients in both groups.
Laboratory values were similar in teenagers and younger patients. The
hospital courses were also similar; seizures occurred in almost 20%, and
hypertension and oligoanuric renal failure occurred in most. Two (12%) of
the teenagers and 7 (2.4%) of the younger patients died during the acute
phase of the syndrome (P = .09); almost 50% of both groups experienced 1 or
more chronic renal sequelae. End-stage renal disease has occurred in 1
(5.8%) of the teenagers and 6 (2.2%) of the children. At follow-up, 1 or
more years (median, 5 years) after the onset of HUS, hypertension was
present in 22% of the teenagers and 6.7% of the preteens (P = .14). A
below-normal glomerular filtration rate was seen in approximately 30% of
both groups; proteinuria was noted in approximately 25% of both groups.
Approximately 10% of both groups had a combination of proteinuria and a low
glomerular filtration rate and are, therefore, at risk for eventual
end-stage renal disease. CONCLUSIONS: In our region of the Intermountain
West, HUS in adolescents closely resembles that seen in children and the
outcome is more favorable than that experienced by adults.
