Inflammatory and immunological parameters in children with haemolytic uremic syndrome (HUS) and gastroenteritis - Pathophysiological and diagnostic clues

The objective of this study was to identify parameters indicating a risk fo r developing typical haemolytic uremic syndrome (D + HUS) during the prodro mal phase of diarrhea caused by enterohaemorrhagic Escherichia coli (EHEC). Forty-eight children were studied prospectively with regard to inflammator y serum factors on admission to hospital. Ten patients developed D+HUS (gro up I), 15 suffered from viral-gastroenteritis (group IIa) and 23 from other types of bacterial gastroenteritis (group IIb). Mean levels of IL-8 tended to be elevated in group I compared to groups IIa and IIb. Neopterin and IL -10 levels particularly were significantly decreased in HUS in comparison t o both gastroenteritis groups. Low IL-10 levels indicate a substantial disr egulation of the immune response in HUS, as IL-10 downregulates the pro-inf lammatory response and suppresses pro-coagulant activity in experimental en dotoxemia. Our results suggest low neopterin, high IL-8 and especially low IL-10 levels are indicators of a high risk for developing HUS. (C) 2000 Aca demic Press.