Background: Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy and a major cause of acute kidney injury in children, representing a heterogeneous group of disorders with different pathophysiology and outcomes, including Shiga toxin–producing Escherichia coli–associated HUS (STEC-HUS) ,post-streptococcus HUS and atypical HUS due to complement dysregulation. Aim: To evaluate the clinical characteristics, prognostic factors and outcome of HUS in children younger than 16 years. Methods: This cohort study included 43 children under 16 years who presented with HUS at the pediatric nephrology unit. Patients were classified into two groups: typical HUS with a diarrheal prodroma (Group A) and atypical HUS without preceding diarrhea (Group B).Results: Group A included 23 patients (53%), while Group B included 20 patients (47%). Males represented (67.4%) while females(32.6%). Complete recovery was significantly more frequent in typical HUS than atypical HUS (61% vs. 30%, p < 0.005). In contrast, chronic kidney disease (55% vs. 21%), proteinuria (75% vs. 30%), and hypertension (90% vs. 65%) were significantly more in atypical HUS. Receiver operating characteristic (ROC) curve analysis showed that a C3 cutoff value of 68 mg/dL predicted chronicity in atypical HUS with a sensitivity of 72%, specificity of 44%, and (AUC) of 0.667. A factor H cutoff value of 51 mg/L demonstrated a sensitivity of 68%, specificity of 55%, and AUC of 0.606. Conclusion: Typical HUS was associated with better renal recovery, while atypical HUS showed worse renal outcomes with higher rates of CKD, proteinuria, and hypertension. Mortality was significantly associated with younger age and convulsions. |
