{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T07:04:08Z","timestamp":1790233448740,"version":"4.1.0"},"reference-count":35,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Hemolytic uremic syndrome associated with Shiga toxin\u2013producing Escherichia coli (STEC-HUS) is a severe acute illness without specific treatment except supportive care; fluid management is concentrated on preventing fluid overload for patients, who are often oligoanuric. Hemoconcentration at onset is associated with more severe disease, but the benefits of volume expansion after hemolytic uremic syndrome (HUS) onset have not been explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>All the children with STEC-HUS referred to our center between 2012 and 2014 received intravenous infusion targeted at inducing an early volume expansion (+10% of working weight) to restore circulating volume and reduce ischemic or hypoxic tissue damage. The short- and long-term outcomes of these patients were compared with those of 38 historical patients referred to our center during the years immediately before, when fluid intake was routinely restricted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Patients undergoing fluid infusion soon after diagnosis showed a mean increase in body weight of 12.5% (vs 0%), had significantly better short-term outcomes with a lower rate of central nervous system involvement (7.9% vs 23.7%, P = .06), had less need for renal replacement therapy (26.3% vs 57.9%, P = .01) or intensive care support (2.0 vs. 8.5 days, P = .02), and needed fewer days of hospitalization (9.0 vs 12.0 days, P = .03). Long-term outcomes were also significantly better in terms of renal and extrarenal sequelae (13.2% vs 39.5%, P = .01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Patients with STEC-HUS had great benefit from early volume expansion. It is speculated that early and generous fluid infusions can reduce thrombus formation and ischemic organ damage, thus having positive effects on both short- and long-term disease outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2015-2153","type":"journal-article","created":{"date-parts":[[2015,12,8]],"date-time":"2015-12-08T09:29:58Z","timestamp":1449566998000},"source":"Crossref","is-referenced-by-count":85,"title":["Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome"],"prefix":"10.1542","volume":"137","author":[{"given":"Gianluigi","family":"Ardissino","sequence":"first","affiliation":[{"name":"Center for HUS Control, Prevention and Management,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Tel","sequence":"additional","affiliation":[{"name":"Center for HUS Control, Prevention and Management,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Possenti","sequence":"additional","affiliation":[{"name":"Center for HUS Control, Prevention and Management,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Testa","sequence":"additional","affiliation":[{"name":"Center for HUS Control, Prevention and Management,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Consonni","sequence":"additional","affiliation":[{"name":"Epidemiology Unit,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Paglialonga","sequence":"additional","affiliation":[{"name":"Center for HUS Control, Prevention and Management,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Salardi","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Genetics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2","family":"Borsa-Ghiringhelli","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Genetics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Salice","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Tedeschi","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Genetics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierangela","family":"Castorina","sequence":"additional","affiliation":[{"name":"Center for HUS Control, Prevention and Management,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosaria Maria","family":"Colombo","sequence":"additional","affiliation":[{"name":"Unit of Microbiology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"Arghittu","sequence":"additional","affiliation":[{"name":"Unit of Microbiology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Daprai","sequence":"additional","affiliation":[{"name":"Unit of Microbiology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Monzani","sequence":"additional","affiliation":[{"name":"Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Novara, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosangela","family":"Tozzoli","sequence":"additional","affiliation":[{"name":"Istituto Superiore di Sanit\u00e0, Roma, Italy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Brigotti","sequence":"additional","affiliation":[{"name":"Univerit\u00e0 di Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erminio","family":"Torresani","sequence":"additional","affiliation":[{"name":"Unit of Microbiology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2016,1,1]]},"reference":[{"issue":"4","key":"2021120907220480900_B1","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1681\/ASN.2004100861","article-title":"Hemolytic uremic syndrome.","volume":"16","author":"Noris","year":"2005","journal-title":"J Am Soc Nephrol"},{"issue":"5","key":"2021120907220480900_B2","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1542\/peds.2005-0785","article-title":"Predictors of fatality in postdiarrheal hemolytic uremic syndrome.","volume":"117","author":"Oakes","year":"2006","journal-title":"Pediatrics"},{"issue":"6","key":"2021120907220480900_B3","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1093\/cid\/cis531","article-title":"An outbreak of Shiga toxin\u2013producing Escherichia coli O104:H4 hemolytic uremic syndrome in Germany: presentation and short-term outcome in children.","volume":"55","author":"Loos","year":"2012","journal-title":"Clin Infect Dis"},{"issue":"19","key":"2021120907220480900_B4","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1056\/NEJMoa1106483","article-title":"Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany.","volume":"365","author":"Frank","year":"2011","journal-title":"N Engl J Med"},{"key":"2021120907220480900_B5","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1093\/oxfordjournals.epirev.a036079","article-title":"The epidemiology of infections caused by Escherichia coli O157:H7, other enterohemorrhagic E. coli, and the associated hemolytic uremic syndrome.","volume":"13","author":"Griffin","year":"1991","journal-title":"Epidemiol Rev"},{"issue":"1","key":"2021120907220480900_B6","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1056\/NEJMoa011033","article-title":"Prothrombotic coagulation abnormalities preceding the hemolytic\u2013uremic syndrome.","volume":"346","author":"Chandler","year":"2002","journal-title":"N Engl J Med"},{"issue":"26","key":"2021120907220480900_B7","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1056\/NEJM200006293422601","article-title":"The risk of the hemolytic\u2013uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections.","volume":"342","author":"Wong","year":"2000","journal-title":"N Engl J Med"},{"key":"2021120907220480900_B8","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/1750-1172-6-60","article-title":"Atypical hemolytic uremic syndrome.","volume":"6","author":"Loirat","year":"2011","journal-title":"Orphanet J Rare Dis"},{"issue":"5","key":"2021120907220480900_B9","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1056\/NEJMc0808527","article-title":"Eculizumab for atypical hemolytic\u2013uremic syndrome.","volume":"360","author":"N\u00fcrnberger","year":"2009","journal-title":"N Engl J Med"},{"issue":"8","key":"2021120907220480900_B10","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1007\/s00467-012-2131-y","article-title":"Atypical hemolytic uremic syndrome in children: complement mutations and clinical characteristics.","volume":"27","author":"Geerdink","year":"2012","journal-title":"Pediatr Nephrol"},{"issue":"4","key":"2021120907220480900_B11","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1053\/j.ajkd.2013.09.020","article-title":"Skin involvement in atypical hemolytic uremic syndrome.","volume":"63","author":"Ardissino","year":"2014","journal-title":"Am J Kidney Dis"},{"issue":"10","key":"2021120907220480900_B12","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1007\/s00467-008-0935-6","article-title":"Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS).","volume":"23","author":"Scheiring","year":"2008","journal-title":"Pediatr Nephrol"},{"issue":"1","key":"2021120907220480900_B13","first-page":"28","article-title":"Clinical and pathological aspects of central nervous system involvement in the haemolytic uraemic syndrome.","volume":"7","author":"Rooney","year":"1971","journal-title":"Aust Paediatr J"},{"issue":"9","key":"2021120907220480900_B14","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1001\/archpedi.1980.02130210053014","article-title":"CNS manifestations of the hemolytic\u2013uremic syndrome. Relationship to metabolic alterations and prognosis.","volume":"134","author":"Bale","year":"1980","journal-title":"Am J Dis Child"},{"issue":"9464","key":"2021120907220480900_B15","first-page":"1073","article-title":"Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome.","volume":"365","author":"Tarr","year":"2005","journal-title":"Lancet"},{"issue":"10","key":"2021120907220480900_B16","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1001\/jama.290.10.1360","article-title":"Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome: a systematic review, meta-analysis, and meta-regression.","volume":"290","author":"Garg","year":"2003","journal-title":"JAMA"},{"issue":"1","key":"2021120907220480900_B17","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s10157-007-0007-4","article-title":"Management of diarrhea-associated hemolytic uremic syndrome in children.","volume":"12","author":"Iijima","year":"2008","journal-title":"Clin Exp Nephrol"},{"issue":"1","key":"2021120907220480900_B18","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1093\/cid\/cis299","article-title":"Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis.","volume":"55","author":"Wong","year":"2012","journal-title":"Clin Infect Dis"},{"issue":"1","key":"2021120907220480900_B19","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/INF.0b013e31823096a8","article-title":"Antibiotic treatment of Escherichia coli O157 infection and the risk of hemolytic uremic syndrome, Minnesota.","volume":"31","author":"Smith","year":"2012","journal-title":"Pediatr Infect Dis J"},{"issue":"6","key":"2021120907220480900_B20","first-page":"357","article-title":"Effect of early fosfomycin treatment on prevention of hemolytic uremic syndrome accompanying Escherichia coli O157:H7 infection.","volume":"52","author":"Ikeda","year":"1999","journal-title":"Clin Nephrol"},{"issue":"26","key":"2021120907220480900_B21","doi-asserted-by":"crossref","first-page":"2561","DOI":"10.1056\/NEJMc1100859","article-title":"Eculizumab in severe Shiga-toxin-associated HUS.","volume":"364","author":"Lapeyraque","year":"2011","journal-title":"N Engl J Med"},{"issue":"10","key":"2021120907220480900_B22","doi-asserted-by":"crossref","first-page":"3807","DOI":"10.1093\/ndt\/gfs394","article-title":"Best supportive care and therapeutic plasma exchange with or without eculizumab in Shiga-toxin-producing E. coli O104:H4 induced haemolytic\u2013uraemic syndrome: an analysis of the German STEC-HUS registry.","volume":"27","author":"Kielstein","year":"2012","journal-title":"Nephrol Dial Transplant"},{"issue":"6","key":"2021120907220480900_B23","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2004-2236","article-title":"Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion.","volume":"115","author":"Ake","year":"2005","journal-title":"Pediatrics"},{"issue":"1","key":"2021120907220480900_B24","doi-asserted-by":"crossref","DOI":"10.1542\/peds.100.1.e12","article-title":"Predictors of hemolytic uremic syndrome in children during a large outbreak of Escherichia coli O157:H7 infections.","volume":"100","author":"Bell","year":"1997","journal-title":"Pediatrics"},{"issue":"2","key":"2021120907220480900_B25","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s00467-014-2918-0","article-title":"Hemoconcentration: a major risk factor for neurological involvement in hemolytic uremic syndrome.","volume":"30","author":"Ardissino","year":"2015","journal-title":"Pediatr Nephrol"},{"issue":"8","key":"2021120907220480900_B26","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1007\/s00467-012-2158-0","article-title":"Dehydration at admission increased the need for dialysis in hemolytic uremic syndrome children.","volume":"27","author":"Balestracci","year":"2012","journal-title":"Pediatr Nephrol"},{"issue":"2","key":"2021120907220480900_B27","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1097\/MPG.0000000000000420","article-title":"Co-infection in children with bloody diarrhea caused by Shiga toxin\u2013producing Escherichia coli: data of the North Italian HUS Network.","volume":"59","author":"Ardissino","year":"2014","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"1","key":"2021120907220480900_B28","first-page":"1","article-title":"KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.","volume":"3","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group","year":"2013","journal-title":"Kidney Int Suppl"},{"issue":"3","key":"2021120907220480900_B29","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0031-3955(16)36251-4","article-title":"The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents.","volume":"34","author":"Schwartz","year":"1987","journal-title":"Pediatr Clin North Am"},{"issue":"6","key":"2021120907220480900_B30","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1097\/INF.0b013e3182074d22","article-title":"Clinical relevance of Shiga toxin concentrations in the blood of patients with hemolytic uremic syndrome.","volume":"30","author":"Brigotti","year":"2011","journal-title":"Pediatr Infect Dis J"},{"key":"2021120907220480900_B31","volume-title":"Modern Epidemiology","author":"Rothman","year":"2008","edition":"3rd ed."},{"issue":"3","key":"2021120907220480900_B32","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0031-3955(16)36251-4","article-title":"The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents","volume":"34","author":"Schwartz","year":"1987","journal-title":"Pediatr Clin North Am"},{"issue":"2","key":"2021120907220480900_B33","doi-asserted-by":"crossref","first-page":"e29","DOI":"10.1016\/j.ejim.2013.12.002","article-title":"Time to change the definition of hemolytic uremic syndrome","volume":"25","author":"Ardissino","year":"2014","journal-title":"Eur J Intern Med"},{"issue":"6","key":"2021120907220480900_B34","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1097\/INF.0b013e3182074d22","article-title":"Clinical relevance of shiga toxin concentrations in the blood of patients with hemolytic uremic syndrome.","volume":"30","author":"Brigotti","year":"2011","journal-title":"Pediatr Infect Dis J"},{"key":"2021120907220480900_B35","volume-title":"Modern epidemiology.","author":"Rothman","year":"2008","edition":"Third Edition"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2015-2153\/1061242\/peds_20152153.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2015-2153\/1061242\/peds_20152153.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T21:03:05Z","timestamp":1639083785000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/137\/1\/e20152153\/52868\/Early-Volume-Expansion-and-Outcomes-of-Hemolytic"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,1,1]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2016,1,1]]},"published-print":{"date-parts":[[2016,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2015-2153","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,1,1]]},"article-number":"e20152153"}}