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- Title
Long-term Renal Prognosis of Diarrhea-Associated Hemolytic Uremic Syndrome: A Systematic Review, Meta-analysis, and Meta-regression.
- Authors
Garg, Amit X.; Suri, Rita S.; Barrowman, Nick; Rehman, Faisal; Matsell, Doug; Rosas-Arellano, M. Patricia; Salvadori, Marina; Haynes, R. Brian; Clark, William F.
- Abstract
Context: The long-term renal prognosis of patients with diarrhea-associated hemolytic uremic syndrome (HUS) remains controversial. Objectives: To quantify the long-term renal prognosis of patients with diarrhea-associated HUS and to identify reasons for different estimates provided in the literature. Data Sources: We searched MEDLINE and Experta Medica (EMBASE) bibliographic databases and conference proceedings, and we contacted experts until February 2003. We also searched the Institute for Scientific Information index and reference lists of all studies that fulfilled our eligibility criteria. The search strategy included the terms hemolytic-uremic syndrome, purpura, thrombotic thrombocytopenic, Escherichia coli O157, longitudinal studies, kidney diseases, hypertension, and proteinuria Study Selection: Any study that followed up 10 or more patients with primary diarrhea-associated HUS for at least 1 year for renal sequelae. Data Extraction: Two authors independently abstracted data on study and patient characteristics, renal measures, outcomes, and prognostic features. Disagreements were resolved by a third author or by consensus. Data Synthesis: Forty-nine studies of 3476 patients with a mean follow-up of 4.4 years (range, 1-22 years at last follow-up) from 18 countries, 1950 to 2001, were summarized. At the time of recruitment, patients were aged 1 month to 18 years. In the different studies, death or permanent end-stage renal disease (ESRD) ranged from 0% to 30%, with a pooled incidence of 12% (95% confidence interval [CI], 10%-15%). A glomerular filtration rate lower than 80 mL/min per 1.73 m[sup 2], hypertension, or proteinuria was extremely variable and ranged from 0% to 64%, with a pooled incidence of 25% (95% CI, 20%-30%). A higher severity of acute illness was strongly associated with worse long-term prognosis. Studies with a higher proportion of patients with central nervous system symptoms (coma, seizures, or stroke) had a higher proportion of patient...
- Subjects
HEMOLYSIS &; hemolysins; DIARRHEA; KIDNEY diseases; PROGNOSIS; PROTEINURIA; HEMOLYTIC anemia
- Publication
JAMA: Journal of the American Medical Association, 2003, Vol 290, Issue 10, p1360
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.290.10.1360