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Blood urea nitrogen to serum creatinine ratio is an accurate predictor of outcome in diarrhea-associated hemolytic uremic syndrome, a preliminary study

Werner Keenswijk (UGent) , Jill Vanmassenhove (UGent) , Ann Raes (UGent) , Evelyn Dhont (UGent) and Johan Vande Walle (UGent)
(2017) EUROPEAN JOURNAL OF PEDIATRICS. 176(3). p.355-360
Author
Organization
Abstract
Diarrhea-associated hemolytic uremic syndrome (D+HUS) is a common thrombotic microangiopathy during childhood and early identification of parameters predicting poor outcome could enable timely intervention. This study aims to establish the accuracy of BUN-to-serum creatinine ratio at admission, in addition to other parameters in predicting the clinical course and outcome. Records were searched for children between 1 January 2008 and 1 January 2015 admitted with D+HUS. A complicated course was defined as developing one or more of the following: neurological dysfunction, pancreatitis, cardiac or pulmonary involvement, hemodynamic instability, and hematologic complications while poor outcome was defined by death or development of chronic kidney disease. Thirty-four children were included from which 11 with a complicated disease course/poor outcome. Risk of a complicated course/poor outcome was strongly associated with oliguria (p = 0.000006) and hypertension (p = 0.00003) at presentation. In addition, higher serum creatinine (p = 0.000006) and sLDH (p = 0.02) with lower BUN-to-serum creatinine ratio (p = 0.000007) were significantly associated with development of complications. A BUN-to-sCreatinine ratio <= 40 at admission was a sensitive and highly specific predictor of a complicated disease course/poor outcome. Conclusion: A BUN-to-serum Creatinine ratio can accurately identify children with D+HUS at risk for a complicated course and poor outcome.
Keywords
NEUROLOGICAL INVOLVEMENT, HEMOCONCENTRATION, RISK, Shigatoxin, Hemolytic uremic syndrome, BUN-to-sCreatinine ratio, Complicated course, Poor outcome, Thrombothic micro-angiopathy (TMA)

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MLA
Keenswijk, Werner, Jill Vanmassenhove, Ann Raes, et al. “Blood Urea Nitrogen to Serum Creatinine Ratio Is an Accurate Predictor of Outcome in Diarrhea-associated Hemolytic Uremic Syndrome, a Preliminary Study.” EUROPEAN JOURNAL OF PEDIATRICS 176.3 (2017): 355–360. Print.
APA
Keenswijk, W., Vanmassenhove, J., Raes, A., Dhont, E., & Vande Walle, J. (2017). Blood urea nitrogen to serum creatinine ratio is an accurate predictor of outcome in diarrhea-associated hemolytic uremic syndrome, a preliminary study. EUROPEAN JOURNAL OF PEDIATRICS, 176(3), 355–360.
Chicago author-date
Keenswijk, Werner, Jill Vanmassenhove, Ann Raes, Evelyn Dhont, and Johan Vande Walle. 2017. “Blood Urea Nitrogen to Serum Creatinine Ratio Is an Accurate Predictor of Outcome in Diarrhea-associated Hemolytic Uremic Syndrome, a Preliminary Study.” European Journal of Pediatrics 176 (3): 355–360.
Chicago author-date (all authors)
Keenswijk, Werner, Jill Vanmassenhove, Ann Raes, Evelyn Dhont, and Johan Vande Walle. 2017. “Blood Urea Nitrogen to Serum Creatinine Ratio Is an Accurate Predictor of Outcome in Diarrhea-associated Hemolytic Uremic Syndrome, a Preliminary Study.” European Journal of Pediatrics 176 (3): 355–360.
Vancouver
1.
Keenswijk W, Vanmassenhove J, Raes A, Dhont E, Vande Walle J. Blood urea nitrogen to serum creatinine ratio is an accurate predictor of outcome in diarrhea-associated hemolytic uremic syndrome, a preliminary study. EUROPEAN JOURNAL OF PEDIATRICS. 2017;176(3):355–60.
IEEE
[1]
W. Keenswijk, J. Vanmassenhove, A. Raes, E. Dhont, and J. Vande Walle, “Blood urea nitrogen to serum creatinine ratio is an accurate predictor of outcome in diarrhea-associated hemolytic uremic syndrome, a preliminary study,” EUROPEAN JOURNAL OF PEDIATRICS, vol. 176, no. 3, pp. 355–360, 2017.
@article{8519908,
  abstract     = {Diarrhea-associated hemolytic uremic syndrome (D+HUS) is a common thrombotic microangiopathy during childhood and early identification of parameters predicting poor outcome could enable timely intervention. This study aims to establish the accuracy of BUN-to-serum creatinine ratio at admission, in addition to other parameters in predicting the clinical course and outcome. Records were searched for children between 1 January 2008 and 1 January 2015 admitted with D+HUS. A complicated course was defined as developing one or more of the following: neurological dysfunction, pancreatitis, cardiac or pulmonary involvement, hemodynamic instability, and hematologic complications while poor outcome was defined by death or development of chronic kidney disease. Thirty-four children were included from which 11 with a complicated disease course/poor outcome. Risk of a complicated course/poor outcome was strongly associated with oliguria (p = 0.000006) and hypertension (p = 0.00003) at presentation. In addition, higher serum creatinine (p = 0.000006) and sLDH (p = 0.02) with lower BUN-to-serum creatinine ratio (p = 0.000007) were significantly associated with development of complications. A BUN-to-sCreatinine ratio <= 40 at admission was a sensitive and highly specific predictor of a complicated disease course/poor outcome. 
Conclusion: A BUN-to-serum Creatinine ratio can accurately identify children with D+HUS at risk for a complicated course and poor outcome.},
  author       = {Keenswijk, Werner and Vanmassenhove, Jill and Raes, Ann and Dhont, Evelyn and Vande Walle, Johan},
  issn         = {0340-6199},
  journal      = {EUROPEAN JOURNAL OF PEDIATRICS},
  keywords     = {NEUROLOGICAL INVOLVEMENT,HEMOCONCENTRATION,RISK,Shigatoxin,Hemolytic uremic syndrome,BUN-to-sCreatinine ratio,Complicated course,Poor outcome,Thrombothic micro-angiopathy (TMA)},
  language     = {eng},
  number       = {3},
  pages        = {355--360},
  title        = {Blood urea nitrogen to serum creatinine ratio is an accurate predictor of outcome in diarrhea-associated hemolytic uremic syndrome, a preliminary study},
  url          = {http://dx.doi.org/10.1007/s00431-016-2846-z},
  volume       = {176},
  year         = {2017},
}

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