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Spizzirri AP, Cobeñas CJ, Alconcher LF, Murray N, Zarate C, Curutchet L, De Rose E, Gogorza MJ, Lucarelli L, Ruscasso J, Lombardi L, Pereyra P, Zalba J, Risso P, Suarez A. Ocular involvement in STEC-associated hemolytic uremic syndrome. Pediatr Nephrol 2022; 37:2699-2703. [PMID: 35524864 DOI: 10.1007/s00467-022-05587-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemolytic uremic syndrome (HUS) is a systemic thrombotic microangiopathy characterized by hemolytic anemia, thrombocytopenia, and variable kidney involvement. Extrarenal thrombotic microangiopathy occurs in central nervous system (CNS), colon, and other organ systems, but ocular involvement is rarely recognized. This study aimed to analyze frequency and severity of ocular involvement in STEC-HUS, and the relationship between ocular involvement and disease severity, with emphasis on CNS, kidney, and colonic disease. METHODS Prospective, longitudinal, observational study. INCLUSION CRITERIA STEC-HUS patients September 2014-January 2019. Funduscopic examination (FE) was performed within 48 h of admission. We evaluated severity of CNS disease, kidney involvement, and presence of hemorrhagic colitis (HC). RESULTS Ninety-nine patients were included (female 52), mean age 39.4 months (DE: 29.8; range 9-132). Thirteen patients (13.1%) had abnormal FE, 10 showing variable degrees of hemorrhagic exudates and 2 with typical Purtscher-like retinopathy. Other findings included tortuous vascularity, cotton wool spots, and transient retinal edema. CNS involvement was present in 16/99 patients, severe in 12 (75%). Abnormal FE occurred in 5/12 (31%) patients with severe CNS involvement vs. 8/87 (9.2%) with mild, moderate, or no CNS disease (p = 0.0191). Abnormal FE was present in 2/33 (6%) patients without dialysis vs. 11/66 (16.6%) requiring dialysis (p = 0.20). Finally, there were FE abnormalities in 6/20 patients with HC vs. 7/79 without HC (p = 0.012). CONCLUSIONS FE abnormalities were present in 13% of HUS patients. Abnormal FE significantly associated with more severe disease, including severe CNS involvement and HC. We suggest FE should be performed in severe HUS, especially in cases with severe CNS disease. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ana P Spizzirri
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina.
| | - Carlos J Cobeñas
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Laura F Alconcher
- Nephrology Unit, Hospital Interzonal General Dr. José Penna. Bahía Blanca, Buenos Aires, Argentina
| | - Néstor Murray
- Ophthalmology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Claudia Zarate
- Ophthalmology Department, Hospital Interzonal General Dr. José Penna, Bahía Blanca, Buenos Aires, Argentina
| | - Laura Curutchet
- Ophthalmology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Emanuel De Rose
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - María José Gogorza
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Lucas Lucarelli
- Nephrology Unit, Hospital Interzonal General Dr. José Penna. Bahía Blanca, Buenos Aires, Argentina
| | - Javier Ruscasso
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Laura Lombardi
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Priscila Pereyra
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Javier Zalba
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Paula Risso
- Cátedra de Bioestadística Bayesiana y Clásica, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina
| | - Angela Suarez
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
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