Clinical Nephrology – Epidemiology – Clinical Trials
Kidney International (2005) 67, 1476–1482; doi:10.1111/j.1523-1755.2005.00225.x
Microalbuminuria three years after recovery from Escherichia coli O157 hemolytic uremic syndrome due to municipal water contamination
AMIT X GARG, WILLIAM F CLARK, MARINA SALVADORI, JENNIFER MACNAB, RITA S SURI, R BRIAN HAYNES and DOUGLAS MATSELL ON BEHALF OF THE WALKERTON HEALTH STUDY INVESTIGATORS
Division of Nephrology, University of Western Ontario, London, Ontario, London; Department of Epidemiology and Biostatistics, University of Western Ontario, London; Division of Pediatric Infectious Diseases, University of Western Ontario, London; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton; and Division of Pediatric Nephrology, University of British Columbia, Vancouver
Correspondence: Dr Amit Garg, Assistant Professor Medicine and Epidemiology, University of Western Ontario, Division of Nephrology, London Kidney Clinical Research Unit, Room A01, Westminster Tower, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 4G5. E-mail:Amit.Garg@lhsc.on.ca
Received 11 August 2004; Revised 28 September 2004; Accepted 14 October 2004.
Abstract
Microalbuminuria three years after recovery from Escherichia coli O157 hemolytic uremic syndrome due to municipal water contamination.
Background
Knowledge of the long-term renal prognosis of diarrhea associated hemolytic uremic syndrome (HUS) is important for patient counseling and follow-up. However, estimates of long-term risk are highly variable, with previous studies not using a healthy control group.
Methods
A municipal water system in the small rural town of Walkerton, Ontario, became contaminated with Escherichia coli O157:H7 in 2000. A cohort of 19 children who recovered from HUS was randomly age- and sex-matched to 38 children with no symptoms at the time of the outbreak. Both groups had detailed renal function testing 3 years after the outbreak, including a random urine albumin to creatinine, glomerular filtration rate estimated by Schwartz formula, and automated and manual blood pressure measurements.
Results
There were no baseline differences between the groups with respect to age (mean 4.8 years, range 1 to 15), sex, or birth weight (mean 3.4 kg). In follow-up there were no differences between the groups in body surface area (mean 1.0 m2), or in the methods by which renal function was assessed. Compared to the group with no symptoms, patients with HUS demonstrated more microalbuminuria [32% vs. 5%, relative risk 4.8 (95% CI 1.1 to 22.0)], a nonsignificant trend toward lower GFR (124 vs. 134 mL/min per 1.73m2), and no difference in blood pressure.
Conclusion
Children may demonstrate microalbuminuria 3 years after recovering from HUS. Longer follow-up is needed to determine if this finding has clinical relevance and utility.
Keywords:
cohort study, Escherichia coli O157, hemolytic-uremic syndrome, hypertension, proteinuria, chronic kidney disease
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RESEARCH
Absence of renal sequelae after childhood Escherichia coli O157:H7 gastroenteritis
Kidney International Original Article
