Pre-HUS volume expansion is associated with less severe episodes of HUS
diarrhea, hyperhydration, STEC, anuria, HUS
ANURIA
In a prospective, single-center study of 29 children with HUS [Additional data from the diarrhea phase pre-HUS suggest the need for, and feasibility of, volume expansion early in illness, to reduce the severity of HUS. McKee et al. studied 866 children infected with STEC, who did not have HUS at initial presentation in a network of 38 North American pediatric emergency departments [A meta-analysis of eight studies and 1511 children [The feasibility of reducing the anuria rate was suggested in a study of 36 STEC-infected children who were admitted to hospital before they developed HUS [These multiple lines of evidence suggest the potential benefits of intravascular volume expansion in STEC-infected children. However, the strength of the conclusions that can be drawn and the impact on clinical care are limited by heterogeneity of design, small numbers, lack of clear protocols, unmeasured confounders, and difficulty differentiating causality from association. Our proposed study aims to resolve this uncertainty by comparing protocolized management of hyperhydration versus conservative fluid management.