alternative pathway; blood urea nitrogen; Complement; eculizumab; escherichia-coli; Hemolytic uremic syndrome; hus; children; involvement; predictors; Renal replacement therapy; serum creatinine ratio; Shiga toxin-producing Escherichia coli

Diarrhea-associated hemolytic uremic syndrome is characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury secondary to enteric infection, typically Shiga toxin-producing Escherichia coli. Shiga toxin 2 is able to activate alternative complement pathways; therefore, the aim of the study was to analyze C3 as a predictor of clinical courses in patients with diarrhea-associated hemolytic uremic syndrome. We hypothesized that the patients with increased complement activation at admission suffered from a more severe course. We retrospectively analyzed data of 33 pediatric patients between 1999 and 2015 in the Czech Republic. We tested the association of a C3 concentration with biochemical parameters and the clinical data reflecting the severity of the disease. We found significant correlation between the initial C3 and the duration of renal replacement therapy (r=-0.62, p=0.0001) and the initial glomerular filtration rate (r=0.36, p=0.026). Patients with C3<0.825g/L needed renal replacement therapy and also had significantly more renal complications (p=0.015).Conclusion: Based on our study, decreased C3 concentrations can be used as one of the risk factors that can help predict the need for acute dialysis and a more severe course of disease in children with diarrhea-associated hemolytic uremic syndrome.