What is the prognosis of Shiga toxin–producing E coli hemolytic-uremic syndrome (STEC-HUS)?

Updated: Nov 12, 2018
  • Author: Robert S Gillespie, MD, MPH; Chief Editor: Craig B Langman, MD  more...
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Answer

Most patients who receive the appropriate treatment have a good recovery. Recurrence is very rare. Poor prognostic indicators include the following:

  • Elevated WBC count at diagnosis

  • Prolonged anuria

  • Severe prodromal illness

  • Severe hemorrhagic colitis with rectal prolapse or colonic gangrene

  • Severe multisystemic involvement

  • Persistent proteinuria

  • Genetic abnormalities in complement regulatory factors

The long-term prognosis for survivors of childhood STEC-HUS remains unknown. A 5-year follow-up of a cohort of patients showed no difference in blood pressure and slightly higher rates of microalbuminuria compared with controls. [46] The patients also had lower glomerular filtration rates (GFRs) as measured by cystatin C but not as measured by serum creatinine levels. Other studies have shown similar findings. Continued long-term follow-up studies are needed to help determine whether survivors have residual subclinical renal injury that could manifest itself later in life. At present, patients should be counseled on avoiding risk factors for renal disease (eg, tobacco use, obesity, hypertension) and the importance of continued medical follow-up.


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