Beyond the kidney: prevalence of extrarenal complications and their long-term sequelae in Shiga toxin-producing Escherichia coli hemolytic uremic syndrome.

backgroundShiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) is a leading cause of acute kidney injury in children, but its systemic nature can lead to extrarenal complications. While long-term kidney sequelae are well-documented, data on the long-term consequences of extrarenal involvement are scarce. This study aimed to determine the prevalence of extrarenal complications in STEC-HUS patients, compare acute phase findings between patients with and without extrarenal involvement, and describe the long-term sequelae.

methodsRetrospective and observational study of 221 children under 18 years old with STEC-HUS admitted between 2005 and 2024. Clinical and laboratory data from the acute phase were analyzed. Extrarenal involvement during the acute phase and the long-term outcome were described.

resultsExtrarenal complications were observed in 46 (21%) patients and nearly half of them had compromise of ≥ 2 organs. Central nervous system involvement was the most frequent and the leading cause of death, followed by severe gastrointestinal, cardiac, and ocular compromise. Patients with extrarenal involvement had a significantly higher mortality rate (15.2% vs. 1%, p < 0.0001) and 91% required dialysis. Multivariate logistic regression analysis identified dialysis requirement, leukocytosis > 16,100 cells/mm

conclusionsExtrarenal involvement was associated with increased morbidity and mortality and a non-negligible prevalence of long-term sequelae. These findings highlight the importance of screening for extrarenal complications and sequelae during long-term follow up.