Kidney sequelae in 281 Shiga toxin–producing Escherichia coli -hemolytic uremic syndrome patients after a median follow-up of 12 years

Background A substantial proportion of patients with Escherichia coli -hemolytic uremic syndrome (STEC-HUS) evolve to chronic kidney disease (CKD). The objectives of this study were to evaluate long-term kidney outcomes and to identify CKD predictors. Methods In this single-center retrospective study, long-term outcomes of patients were analyzed according to the presence of complete recovery (CR) or CKD at last visit. Then, they were grouped into favorable (CR + CKD1) or poor (CKD2–5) outcome to compare predictors at diagnosis (sex, age, leukocytes, creatinine, hemoglobin, HUS severity score), dialysis duration, and follow-up time between them. Results Of 281 patients followed up for a median of 12 years, 139 (49%) had CR, 104 (37%) CKD1, 27 (10%) CKD2–4, and 11 (4%) CKD5. Thirty-eight patients progressed to CKD2–5 after a median of 4.8 years, 7% in the first 5 years, increasing to 8%, 10%, and 14% after 5–10 years, 10–15 years, and > 15 years, respectively. They were younger, had higher baseline hemoglobin and leukocytes, and required longer dialysis and follow-up than those with favorable outcome. By multivariate analysis, days of dialysis and follow-up time remained as independent predictors of poor outcome. The best cutoff for days of dialysis was 10 days. After 5 years, 20% of those dialyzed ≥ 10 days evolved to CKD2–5 versus 1% of those non-dialyzed or dialyzed < 10 days. Conclusions Fifty-one percent of patients evolved to CKD after 12 years of follow-up and 14% to CKD2–5. Ten days of dialysis was the best cutoff to recognize outcomes. In some cases, kidney damage was evident after 15 years of surveillance, highlighting the need for follow-up until adulthood in all STEC-HUS patients. Graphical Abstract A higher resolution version of the Graphical abstract is available as Supplementary information