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Background <p>Shiga toxin-producing <i>Escherichia coli</i> hemolytic uremic syndrome (STEC-HUS) is a leading cause of acute kidney injury in children, but its systemic nature can lead to extrarenal complications. While long-term kidney sequelae are well-documented, data on the long-term consequences of extrarenal involvement are scarce. This study aimed to determine the prevalence of extrarenal complications in STEC-HUS patients, compare acute phase findings between patients with and without extrarenal involvement, and describe the long-term sequelae.</p> Methods <p>Retrospective and observational study of 221 children under 18&#xa0;years old with STEC-HUS admitted between 2005 and 2024. Clinical and laboratory data from the acute phase were analyzed. Extrarenal involvement during the acute phase and the long-term outcome were described.</p> Results <p>Extrarenal complications were observed in 46 (21%) patients and nearly half of them had compromise of ≥ 2 organs. Central nervous system involvement was the most frequent and the leading cause of death, followed by severe gastrointestinal, cardiac, and ocular compromise. Patients with extrarenal involvement had a significantly higher mortality rate (15.2% vs. 1%, <i>p</i> &lt; 0.0001) and 91% required dialysis. Multivariate logistic regression analysis identified dialysis requirement, leukocytosis &gt; 16,100 cells/mm<sup>3</sup>, arterial hypertension, and dehydration as independent variables associated with extrarenal complications. After a median follow-up of 6.4&#xa0;years, five patients (11%) developed long-term sequelae: two neurological, two gastrointestinal, and one ocular.</p> Conclusions <p>Extrarenal involvement was associated with increased morbidity and mortality and a non-negligible prevalence of long-term sequelae. These findings highlight the importance of screening for extrarenal complications and sequelae during long-term follow up.</p> Graphical Abstract <p>A higher resolution version of the&#xa0;Graphical abstract is available as <InternalRef RefID="MOESM1">Supplementary information</InternalRef></p> <p></p>

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Beyond the kidney: prevalence of extrarenal complications and their long-term sequelae in Shiga toxin-producing Escherichia coli hemolytic uremic syndrome

  • 期刊论文

  • 发表日期：

    2026年6月2日

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  • Laura F. Alconcher,
  • Lucas I. Lucarelli,
  • Sabrina Bronfen,
  • Fernanda Villarreal

摘要

Background

Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) is a leading cause of acute kidney injury in children, but its systemic nature can lead to extrarenal complications. While long-term kidney sequelae are well-documented, data on the long-term consequences of extrarenal involvement are scarce. This study aimed to determine the prevalence of extrarenal complications in STEC-HUS patients, compare acute phase findings between patients with and without extrarenal involvement, and describe the long-term sequelae.

Methods

Retrospective and observational study of 221 children under 18 years old with STEC-HUS admitted between 2005 and 2024. Clinical and laboratory data from the acute phase were analyzed. Extrarenal involvement during the acute phase and the long-term outcome were described.

Results

Extrarenal complications were observed in 46 (21%) patients and nearly half of them had compromise of ≥ 2 organs. Central nervous system involvement was the most frequent and the leading cause of death, followed by severe gastrointestinal, cardiac, and ocular compromise. Patients with extrarenal involvement had a significantly higher mortality rate (15.2% vs. 1%, p < 0.0001) and 91% required dialysis. Multivariate logistic regression analysis identified dialysis requirement, leukocytosis > 16,100 cells/mm3, arterial hypertension, and dehydration as independent variables associated with extrarenal complications. After a median follow-up of 6.4 years, five patients (11%) developed long-term sequelae: two neurological, two gastrointestinal, and one ocular.

Conclusions

Extrarenal involvement was associated with increased morbidity and mortality and a non-negligible prevalence of long-term sequelae. These findings highlight the importance of screening for extrarenal complications and sequelae during long-term follow up.

Graphical Abstract

A higher resolution version of the Graphical abstract is available as Supplementary information