{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:06:47Z","timestamp":1760144807593,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T00:00:00Z","timestamp":1716249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Shiga toxin-producing Escherichia coli\u2013haemolytic uremic syndrome (STEC-HUS) can result in kidney and neurological complications. Early volume-expansion therapy has been shown to improve outcomes, but caution is required to avoid fluid overload. Lung ultrasound scanning (LUS) can be used to detect fluid overload and may be useful in monitoring hydration therapy. Methods: This prospective observational pilot study involved children with STEC-HUS who were recruited from a regional paediatric nephrology centre. B-line quantification by LUS was used to assess fluid status at the emergency department (ED) admission and correlated with the decrease in patient weight from the target weight. A control group of children on chronic dialysis therapy with episodes of symptomatic fluid overload was also enrolled in order to establish a B-line threshold indicative of severe lung congestion. Another cohort of \u201chealthy\u201d children, without renal or lung-related diseases, and without clinical signs of fluid overload was also enrolled in order to establish a B-line threshold indicative of euvolemia. Results: LUS assessment was performed in 10 children with STEC-HUS at ED admission, showing an average of three B-lines (range 0\u201310). LUS was also performed in 53 euvolemic children admitted to the ED not showing kidney and lung disease (healthy controls), showing a median value of two B-lines (range 0\u20137), not significantly different from children with STEC-HUS at admission (p = 0.92). Children with STEC-HUS with neurological involvement during the acute phase and those requiring dialysis presented a significantly lower number of B-lines at admission compared to patients with a good clinical course (p &lt; 0.001). Patients with long-term renal impairment also presented a lower number of B-lines at disease onset (p = 0.03). Conclusions: LUS is a useful technique for monitoring intravenous hydration therapy in paediatric patients with STEC-HUS. A low number of B-lines at ED admission (&lt;5 B-lines) was associated with worse short-term and long-term outcomes. Further studies are needed to determine the efficacy and safety of an LUS-guided strategy for reducing complications in children with STEC-HUS.<\/jats:p>","DOI":"10.3390\/jcm13113024","type":"journal-article","created":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T05:40:47Z","timestamp":1716270047000},"page":"3024","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lung Ultrasound to Evaluate Fluid Status and Optimize Early Volume-Expansion Therapy in Children with Shiga Toxin-Producing Escherichia Coli\u2013Haemolytic Uremic Syndrome: A Pilot Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9949-3543","authenticated-orcid":false,"given":"Marco","family":"Allinovi","sequence":"first","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Farella","sequence":"additional","affiliation":[{"name":"Clinica Medica \u201cA. Murri\u201d, Department of Biomedical Sciences & Human Oncology, University of Bari \u201cAldo Moro\u201d, 70121 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Giacalone","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Trauma Center, Meyer University Children\u2019s Hospital IRCCS, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6626-3258","authenticated-orcid":false,"given":"Gianmarco","family":"Lugli","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0440-7356","authenticated-orcid":false,"given":"Luigi","family":"Cirillo","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit, Meyer Children\u2019s Hospital IRCCS, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niccol\u00f2","family":"Parri","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Trauma Center, Meyer University Children\u2019s Hospital IRCCS, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1011-7291","authenticated-orcid":false,"given":"Francesca","family":"Becherucci","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit, Meyer Children\u2019s Hospital IRCCS, 50139 Florence, Italy"},{"name":"Department of Biomedical, Experimental and Clinical Sciences \u201cMario Serio\u201d, University of Florence, 50121 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0140-6736(17)30062-4","article-title":"Haemolytic uraemic syndrome","volume":"390","author":"Fakhouri","year":"2017","journal-title":"Lancet"},{"key":"ref_2","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"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1007\/s00467-020-04876-x","article-title":"Acute peritoneal dialysis, complications and outcomes in 389 children with STEC-HUS: A multicenter experience","volume":"36","author":"Coccia","year":"2021","journal-title":"Pediatr. 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