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Early volume expansion during diarrhea and relative nephroprotection during subsequent hemolytic uremic syndrome.
Hickey, Christina A; Beattie, T James; Cowieson, Jennifer; Miyashita, Yosuke; Strife, C Frederic; Frem, Juliana C; Peterson, Johann M; Butani, Lavjay; Jones, Deborah P; Havens, Peter L; Patel, Hiren P; Wong, Craig S; Andreoli, Sharon P; Rothbaum, Robert J; Beck, Anne M; Tarr, Phillip I.
Afiliación
  • Hickey CA; Division of Gastroenterology and Nutrition, Department of Pediatrics, Washington University School of Medicine, 1 Children's Place, St Louis, MO 63110, USA.
Arch Pediatr Adolesc Med ; 165(10): 884-9, 2011 Oct.
Article en En | MEDLINE | ID: mdl-21784993
OBJECTIVES: To determine if interventions during the pre-hemolytic uremic syndrome (HUS) diarrhea phase are associated with maintenance of urine output during HUS. DESIGN: Prospective observational cohort study. SETTINGS: Eleven pediatric hospitals in the United States and Scotland. PARTICIPANTS: Children younger than 18 years with diarrhea-associated HUS (hematocrit level <30% with smear evidence of intravascular erythrocyte destruction), thrombocytopenia (platelet count <150 × 10³/mm³), and impaired renal function (serum creatinine concentration > upper limit of reference range for age). INTERVENTIONS: Intravenous fluid was given within the first 4 days of the onset of diarrhea. OUTCOME MEASURE: Presence or absence of oligoanuria (urine output ≤ 0.5 mL/kg/h for >1 day). RESULTS: The overall oligoanuric rate of the 50 participants was 68%, but was 84% among those who received no intravenous fluids in the first 4 days of illness. The relative risk of oligoanuria when fluids were not given in this interval was 1.6 (95% confidence interval, 1.1-2.4; P = .02). Children with oligoanuric HUS were given less total intravenous fluid (r = -0.32; P = .02) and sodium (r = -0.27; P = .05) in the first 4 days of illness than those without oligoanuria. In multivariable analysis, the most significant covariate was volume infused, but volume and sodium strongly covaried. CONCLUSIONS: Intravenous volume expansion is an underused intervention that could decrease the frequency of oligoanuric renal failure in patients at risk of HUS.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Oliguria / Diarrea / Lesión Renal Aguda / Fluidoterapia / Síndrome Hemolítico-Urémico Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: Arch Pediatr Adolesc Med Asunto de la revista: PEDIATRIA Año: 2011 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Oliguria / Diarrea / Lesión Renal Aguda / Fluidoterapia / Síndrome Hemolítico-Urémico Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: Arch Pediatr Adolesc Med Asunto de la revista: PEDIATRIA Año: 2011 Tipo del documento: Article País de afiliación: Estados Unidos