Complement activation is associated with more severe course of diarrhea-associated hemolytic uremic syndrome, a preliminary study
L Karnisova, O Hradsky, K Blahova, F Fencl… - European journal of …, 2018 - Springer
L Karnisova, O Hradsky, K Blahova, F Fencl, Z Dolezel, T Zaoral, J Zieg
European journal of pediatrics, 2018•SpringerDiarrhea-associated hemolytic uremic syndrome is characterized by hemolytic anemia,
thrombocytopenia, and acute kidney injury secondary to enteric infection, typically Shiga
toxin-producing Escherichia coli. Shiga toxin 2 is able to activate alternative complement
pathways; therefore, the aim of the study was to analyze C3 as a predictor of clinical courses
in patients with diarrhea-associated hemolytic uremic syndrome. We hypothesized that the
patients with increased complement activation at admission suffered from a more severe …
thrombocytopenia, and acute kidney injury secondary to enteric infection, typically Shiga
toxin-producing Escherichia coli. Shiga toxin 2 is able to activate alternative complement
pathways; therefore, the aim of the study was to analyze C3 as a predictor of clinical courses
in patients with diarrhea-associated hemolytic uremic syndrome. We hypothesized that the
patients with increased complement activation at admission suffered from a more severe …
Abstract
Diarrhea-associated hemolytic uremic syndrome is characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury secondary to enteric infection, typically Shiga toxin-producing Escherichia coli. Shiga toxin 2 is able to activate alternative complement pathways; therefore, the aim of the study was to analyze C3 as a predictor of clinical courses in patients with diarrhea-associated hemolytic uremic syndrome. We hypothesized that the patients with increased complement activation at admission suffered from a more severe course. We retrospectively analyzed data of 33 pediatric patients between 1999 and 2015 in the Czech Republic. We tested the association of a C3 concentration with biochemical parameters and the clinical data reflecting the severity of the disease. We found significant correlation between the initial C3 and the duration of renal replacement therapy (r = − 0.62, p = 0.0001) and the initial glomerular filtration rate (r = 0.36, p = 0.026). Patients with C3 < 0.825 g/L needed renal replacement therapy and also had significantly more renal complications (p = 0.015).
Conclusion: Based on our study, decreased C3 concentrations can be used as one of the risk factors that can help predict the need for acute dialysis and a more severe course of disease in children with diarrhea-associated hemolytic uremic syndrome.
What is Known:
• Shiga toxin modulates the function of complement regulatory proteins and thus contributes to complement activation in patients with diarrhea-associated hemolytic uremic syndrome.
• Risk factors that can predict the need for acute renal replacement therapy and poor outcome in patients with diarrhea-associated hemolytic uremic syndrome are mainly the combination of oligoanuria, dehydration, leukocytosis, high hematocrit > 23%, and neurological involvement.
What is New:
• A lowered concentration of C3 at the time of initial presentation of diarrhea-associated hemolytic uremic syndrome was associated with more severe renal failure and the need for renal replacement therapy along with the development of more extra renal complications.
• Decreased C3 at admission can predict complicated course of diarrhea-associated hemolytic uremic syndrome.
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