E. coli-associated oligoanuria prevented by iv volume expansion
MedWire News: Intravenous (iv) volume expansion during the first 4 days of diarrhea due to Escherichia coli O157:H7 infection may protect from oligoanuria in children who subsequently develop hemolytic uremic syndrome (HUS), suggest study findings.
The findings are of clinical importance, given the high number of enterohemorrhagic E. coli infections (>3000 cases) and hemolytic uremic syndrome (900 cases) reported in 16 countries since the outbreak began earlier this year in Germany.
Phillip Tarr (Washington University School of Medicine, St Louis, Missouri, USA) and co-authors administered iv fluid within the first 4 days of diarrhea onset in 25 children aged younger than 18 years with diarrhea-associated HUS (hematocrit level <30% with smear evidence of intravascular erythrocyte destruction). The patients also had thrombocytopenia (platelet count <150x103/mm3), and impaired renal function (serum creatinine concentration > upper limit of reference range for age).
When the researchers compared these children who received iv fluids with those who did not (n=25), they observed a significantly higher rate of oligoanuria among the latter, at 84% versus 52%. Indeed, children were 1.6-fold more likely to become oligoanuric if no iv fluids were given during the first 4 pre-HUS days.
Of the 34 children with oligoanuric HUS, 33 reached the oligoanuric threshold before the 10th day of illness.
Children with oligoanuric HUS were given significantly less total is fluid and sodium within the first 4 days of illness than those without oligoanuria, at 1.3 vs 3.8 l/m2 and 170 vs 370 mEq/m2, respectively.
Multivariate analysis revealed that the most significant covariate was volume infused, but volume and sodium strong co-varied.
Writing the in the Archives of Pediatric & Adolescent Medicine, the researchers conclude: "Because presence and/or duration of oligoanuria are so repeatedly associated with long-term sequelae in children with HUS, it seems appropriate to prioritize maintenance of urine output during HUS, even though our data do not permit us to state that pre-HUS iv volume expansion prevents long-term renal sequelae."
By Ingrid Grasmo