TY - JOUR
T1 - Absence of renal sequelae after childhood Escherichia coli O157:H7 gastroenteritis
AU - Garg, A. X.
AU - Clark, W. F.
AU - Salvadori, M.
AU - Thiessen-Philbrook, H. R.
AU - Matsell, D.
N1 - Funding Information:
The Kidney Foundation of Canada and Ontario Ministry of Health and Long Term Care provided grant support for this project. Dr Garg is supported by a Clinician Scientist Award from the Canadian Institutes of Health Research. The study sponsors had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. We thank Ms Arlene Richards and all staff and students who assisted with data collection. The corresponding author had full access to the data in the study, and takes final responsibility for the accuracy of the analysis. The article was drafted by Amit Garg. Amit Garg, William Clark, Marina Salvadori, and Douglas Matsell contributed to the conception and design of the study, and acquisition of the data. Amit Garg and Heather Thiessen-Philbrook performed the statistical analysis. All authors revised the manuscript for intellectual content and gave their final approval of the version to be published.
PY - 2006/8/28
Y1 - 2006/8/28
N2 - Although a quarter of children who survive diarrhea-associated hemolytic uremic syndrome develop long-term renal sequelae, the prognosis of acute, self-limited Escherichia coli O157:H7 gastroenteritis has never been previously studied. Four years after a drinking water outbreak of E. coli O157:H7, we examined the risk of high blood pressure (>95th percentile expected for age, sex, and height), reduced kidney function, and microalbuminuria among previously healthy children and adolescents. Of the 951 participants, 313 were asymptomatic during the outbreak, 305 had moderate symptoms of acute gastroenteritis, and 333 had severe symptoms that necessitated medical attention. An additional 23 children who developed hemolytic uremic syndrome during the outbreak were excluded from this analysis. There were no differences in mean systolic blood pressure between those who had no, moderate, or severe symptoms of acute gastroenteritis during the outbreak (109, 110, and 107 mm Hg). Similarly, there were no group differences in diastolic blood pressure, estimated glomerular filtration rate, or random urine albumin to creatinine ratio (P ranged from 0.14 to 0.52), or in the adjusted relative risk of high blood pressure, a glomerular filtration rate <80 ml/min per 1.73 m 2, or microalbuminuria (P ranged from 0.23 to 0.89). Patients who presented to medical attention with gastroenteritis during this E. coli O157:H7 outbreak had an absence of renal sequelae 4 years later. With no existing data to support screening after self-limited E. coli O157:H7 gastroenteritis, we recommend that only those children who develop recognized features of hemolytic uremic syndrome be followed for long-term renal health.
AB - Although a quarter of children who survive diarrhea-associated hemolytic uremic syndrome develop long-term renal sequelae, the prognosis of acute, self-limited Escherichia coli O157:H7 gastroenteritis has never been previously studied. Four years after a drinking water outbreak of E. coli O157:H7, we examined the risk of high blood pressure (>95th percentile expected for age, sex, and height), reduced kidney function, and microalbuminuria among previously healthy children and adolescents. Of the 951 participants, 313 were asymptomatic during the outbreak, 305 had moderate symptoms of acute gastroenteritis, and 333 had severe symptoms that necessitated medical attention. An additional 23 children who developed hemolytic uremic syndrome during the outbreak were excluded from this analysis. There were no differences in mean systolic blood pressure between those who had no, moderate, or severe symptoms of acute gastroenteritis during the outbreak (109, 110, and 107 mm Hg). Similarly, there were no group differences in diastolic blood pressure, estimated glomerular filtration rate, or random urine albumin to creatinine ratio (P ranged from 0.14 to 0.52), or in the adjusted relative risk of high blood pressure, a glomerular filtration rate <80 ml/min per 1.73 m 2, or microalbuminuria (P ranged from 0.23 to 0.89). Patients who presented to medical attention with gastroenteritis during this E. coli O157:H7 outbreak had an absence of renal sequelae 4 years later. With no existing data to support screening after self-limited E. coli O157:H7 gastroenteritis, we recommend that only those children who develop recognized features of hemolytic uremic syndrome be followed for long-term renal health.
KW - Cohort study
KW - Escherichia coli O157
KW - Gastroenteritis
KW - Renal
KW - Risk
KW - Water supply
UR - http://www.scopus.com/inward/record.url?scp=33747074858&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33747074858&partnerID=8YFLogxK
U2 - 10.1038/sj.ki.5001645
DO - 10.1038/sj.ki.5001645
M3 - Article
C2 - 16837926
AN - SCOPUS:33747074858
SN - 0085-2538
VL - 70
SP - 807
EP - 812
JO - Kidney international
JF - Kidney international
IS - 4
ER -