Biomarkers of Hemolytic Uremic Syndrome development and dialysis requirement in children with Shiga toxin-producing E. coli infection.

Abstract

Abstract Background Hemolytic uremic syndrome (HUS) is a disease characterized by thrombocytopenia, microangiopathic hemolytic anemia and acute kidney Injury. We aimed to dose serum concentrations of Interleukin (IL)-8, Tumor Necrosis Factor- α (TNF-α), IL-6, IL-1β and human neutrophil gelatinase-associated lipocalin (N-gal) in children with Shiga toxin-producing E. coli infection (STEC) to determine the inflammatory cytokine profile and the role of these molecules as biomarkers of HUS development and dialysis requirement.Methods Three groups of patients with evidence of STEC were incorporated: those with bloody diarrhea (BD), HUS patients requiring dialysis (HUSD) and HUS patients with no dialysis requirement (HUSND). Serum samples were assayed for cytokines and N-gal using immunoassays.Results Thirty-six children were enrolled (median age: 30.5 (IQR 20–75) months; Female/Male 21/15). Thirteen BD children, ten HUSND children and 13 patients with HUSD were incorporated. We found significantly higher levels of IL-8, IL-6 and TNF-α in HUSD patients compared to BD patients. By contrast, only TNF-α levels were significantly higher in HUSND than in BD patients. Higher IL-8 and N-gal levels were evidenced in HUSD than in HUSND. Principal Component Analysis (PCA) revealed distinct cytokine profiles among the study groups.Conclusions These results suggest that TNF-α could be a risk biomarker for HUS development. We can postulate N-gal and IL-8 as possible biomarkers of dialysis requirement in patients with STEC associated HUS as these molecules were increased at the initial stages of the disease in patients requiring dialysis. Children with HUSD exhibited an immune profile different from the other study groups.