Ambulatory blood pressure monitoring after recovery from hemolytic uremic syndrome

The outcome of acute renal failure due to diarrhea-associated hemolytic ure mic syndrome (D+ HUS) is generally predicted to be good. However, there are only a few long-term observations with detailed reports on long-term seque lae. Specifically, adequate long-term blood pressure (BP) evaluations are s carce. The present study evaluated BP in pediatric patients after childhood D+ HUS. The study group comprised 28 patients (20 males) aged 6-23.5 years (median 10.1 years). All patients had a history of D+ HUS at a median age of 1.1 years (range 0.5-6 years). Based on the duration of oliguria and/or anuria, the primary disease was classified as mild (n=6), moderate (n=6), o r severe (n=16). The BP in these patients was studied at a median time of 8 .4 years (range 2.3-22.9 years) after manifestation of D+ HUS by means of o ffice BP measurements and 24-h ambulatory BP monitoring (ABPM) using a Spac elabs 90207 oscillometric monitor. Measurements were compared with normal v alues of published standards for healthy children and adolescents. Conventi onal office BP measurements were above the 95th percentile in I patient. By ABPM, 2 patients were diagnosed to have mean systolic daytime and nighttim e values in the hypertensive range, and systolic and diastolic hypertension was confirmed in the first patient. All these patients had a severe form o f D+ HUS in the past. By applying ABPM, BP anomalies were detected in 5 add itional patients. Elevated systolic BP loads were found in 4 patients, and daytime systolic and diastolic hypertension in the other 1. At the time of the study, 2 of them were classified as "recovered." The late outcome of D HUS may be worse than anticipated. BP anomalies as long-term sequelae of D + HUS could be identified by ABPM but not by office BP measurements. These findings may represent an isolated sign of residual renal disturbance.