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Personal Injury and Wrongful Death

Long-Term Kidney Complications from HUS

The following article was written by Fred Pritzker, lead attorney for our E. coli cases. To contact Fred for a free consultation, call 1-888-377-8900 (toll free) or submit our free consultation form.

A 2003 study appearing in the prestigious Journal of the American Medical Association (JAMA) entitled “Long-term Renal Prognosis of Diarrhea-Associated Hemolytic Uremic Syndrome” analyzed almost 50 other journal articles on the subject and found that 25% of people who developed hemolytic uremic syndrome (HUS) had long-term kidney problems resulting from the disease.

What are those kidney complications?

There are three primary kidney complications: decreased glomerular filtration rate (GFR), hypertension and/or proteinuria.

Decreased GFR
GFR is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the tiny filters in the kidneys, called glomeruli, each minute.
The GFR test measures how well your kidneys are filtering a waste called creatinine, which is produced by the muscles. When the kidneys aren't working as well as they should, creatinine builds up in the blood.

According to the National Kidney Foundation, normal GFR results range from 90 - 120 mL/min. Older people will have lower normal GFR levels, because GFR decreases with age.
Levels below 60 mL/min for 3 or more months are a sign of chronic kidney disease. Those with GFR results below 15 mL/min are a sign of kidney failure.

Hypertension
Hypertension is high blood pressure. In this context, it is usually defined as requiring antihypertensive medication or blood pressure measurement higher than the 90th percentile.
Uncontrolled high blood pressure can lead to a number of problems including artery damage, aneurysm, heart failure, stroke and other serious problems. At a minimum, it requires medical monitoring and medication.

Hypertension also increases the risk of further kidney disease.

Proteinuria
Proteinuria is the presence of excessive amounts of protein in the urine. It occurs in the context of HUS as a result of decreased kidney function. It is a sign of chronic kidney disease.

If my child appears to have made a complete recovery from acute HUS, does that mean there will never be any
future kidney problems?

The usual measure of full recovery following HUS is a normal GFR.
According to some studies, the presence of a normal GFR following acute HUS does not guarantee long-term kidney health, although the data is far from conclusive. For example, in four studies of patients who apparently completely recovered after acute illness, anywhere from 8% to 61% went on to develop a lower-than-normal GFR, hypertension or proteinuria during long-term follow-up.

Other studies, however, seem to indicate that full recovery following acute HUS means there will be no future complications. These studies are limited by follow-up times of five years or less which means that the full extent of future problems requires further study.

Are there problems other than kidney damage
that my child may experience as a result of HUS?

Sadly, kidney damage is not the only problem that can result from HUS.

Other complications include neurological deficits (acute and chronic), diabetes and gastrointestinal problems.

Studies about the long-term problems associated with these complications are inconsistent. For example, in one study of patients with HUS who had major neurological symptoms during their acute illness, on long-term follow-up they continued to show subtle neurological deficits including posturing, clumsiness, poor fine-motor coordination, hyperactivity and distractibility.

A recent study involving adults with complications similar to HUS (thrombotic thrombocytopenic purpura (TTP)) noted that “After recovery, patients have significantly abnormal health-related quality of  life; neurocognitive studies have documented deficits of attention, processing speed and memory, and also fatigue.”

Contact Pritzker Olsen

Attorney Fred Pritzker represents E. coli and HUS victims and their families nationwide.

A recent report about the long-term outcomes of selected foodborne pathogens, including E. coli O157:H7, may be found at http://www.foodborneillness.org/CFIFinalReport.pdf. Another study appearing in JAMA entitled Long-term Renal Prognosis of Diarrhea-Associated Hemolytic Uremic Syndrome: A Systematic Review, Meta-analysis, and Meta-regression may be downloaded at http://jama.ama-assn.org/cgi/content/full/290/10/1360. 

 


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