Ultrasound analysis of different forms of hemolytic uremic syndrome in children

• Published in: Frontiers in pediatrics 2024-10, Vol.12, p.1433812
• Main Authors: Rink, Lydia, Finkelberg, Ilja, Kreuzer, Martin, Schipper, Lukas, Pape, Lars, Cetiner, Metin
• Format: Article
• Language: English
• Subjects: acute kidney failure; complement activation; dialysis; hemolytic uremic syndrome; Pediatrics; renal size; ultrasound
• ISSN: 2296-2360; 2296-2360
• DOI: 10.3389/fped.2024.1433812

Hemolytic uremic syndrome (HUS) is the most common cause of acute kidney injury in children. It is mainly caused by Shiga toxin-producing enterohemorrhagic (EHEC; STEC-HUS) and is more rarely caused by uncontrolled complement activation (cHUS). Renal replacement therapy is frequently required and kidney function recovers in the majority of patients. Ultrasound (US) is the preferred imaging modality for the evaluation of any renal failure. The aim of this study is the evaluation of US diagnostics in both HUS types at disease onset and in the course of the disease. Clinical, laboratory, and US data from the digital patient records of children admitted as inpatients with a diagnosis of HUS were recruited for a monocentric, retrospective analysis. STEC-HUS and cHUS were diagnosed when, in addition to the laboratory constellation, EHEC infection and complement system activation were verified, respectively. US examinations were performed by pediatricians with certified pediatric US experience. In total, 30 children with STEC-HUS (13/25 male; median age of disease onset 2.9 years; most prevalent EHEC serotype was O157) and cHUS (2/5 male; median age of disease onset 5.4 years; 3/5 with proven pathogenic variation) were included. Renal replacement therapy proportions were comparable in the STEC-HUS and cHUS patients (64% vs. 60%). The resistance index (RI) was elevated at disease onset in the patients with STEC-HUS and cHUS (0.88 ± 0.10 vs. 0.77 ± 0.04,  = 0.13) and was similar in the STEC-HUS subcohorts divided based on dialysis requirement (yes: 0.86 ± 0.1; no: 0.88 ± 0.1;  = 0.74). Total kidney size at disease onset displayed a positive correlation with dialysis duration (R = 0.53,  = 0.02) and was elevated in both HUS types (177% ± 56 and 167% ± 53). It was significantly higher in the STEC-HUS subcohort which required dialysis (200.7% vs. 145%,