Original article
Epidemiology of hemolytic-uremic syndrome in Canadian children from 1986 to 1988*,

https://doi.org/10.1016/S0022-3476(05)80730-9Get rights and content

Abstract

Objective:

To define the epidemiologic features of childhood hemolytic-uremic syndrome (HUS) on a national level in Canada, to determine the proportion of patients in whom Escherichia coli O157:H7 was isolated from stools, and to examine risk factors for more severe HUS.

Design:

From January 1986 to December 1988, patients with HUS were reported prospectively to the Canadian Pediatric Kidney Disease Reference Centre, a national registry for pediatric renal disorders, or were identified retrospectively through a medical records search at participating institutions.

Setting:

All children's hospitals in Canada and the children's wards of general hospitals in Canadian cities with populations greater than 350,000.

Patients:

Two hundred twenty-six children, including 126 girls.

Measurements and main results:

The average annual incidence of HUS in children younger than 15 years was 1.44 per 100,000; the peak age-specific incidence was 3.11 per 100,000 younger than 5 years. The incidence of HUS varled by region; the risk of HUS in Alberta was 2.9 times that in Ontario (p<0.0001). Of the 169 patients whose stools were screened, E. coli O157:H7 was isolated in 87 (51%). Risk factors for prolonged dialysis or death included young age, seizures, elevated white blood cell count at admission to hospital, and shorter, more severe prodromal illness. The rate of dialysis was higher in female patients (55% vs 39%; p=0.02).

Conclusions:

HUS is relatively common in Canadian children younger than 5 years, and is strongly associated with E. coli O157:H7 infection. Reasons for the striking regional variation in the incidence of HUS and for the increased rate of dialysis in female patients are unexplained and deserve further investigation.

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    *

    Supported by grants from the Kidney Foundation of Canada and the Children's Hospital of Eastern Ontario Foundation

    This study would not have been possible without the active collaboration of the following participants in the Canadian Pediatric Kidney Disease Reference Centre: James Carter, David Lirenman, British Columbia Children's Hospital, Vancouver, B.C.; Lane Robson, Alberta Children's Hospital, Calgary, Alberta; Frances Harley, Daniel Hasinoff, University of Alberta Hospital, Edmonton, Alberta; Robert Walker, Winnipeg Children's Hospital, Winnipeg, Manitoba; William Clark, Victoria Hospital, London, Ontario; Brian Steele, Children's Hospital at Chedoke-McMaster University Medical Centre, Hamilton, Ontario; Gerald Arbus, J. W. Balfe, Allison Eddy, Denis Geary, Diane Hébert, Hospital for Sick Children, Toronto, Ontario; David Alexander, Hotel Dieu Hospital, Kingston, Ontario; Peter Morrin, Moussa Cohanim, Edwin Toffelmire, Michael Singer, Bryce Kiberd, Kingston General Hospital, Kingston, Ontario; Norman Wolfish, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Lorraine Bell, Keith Drummond, Paul Goodyer, Bernard Kaplan, Montreal Children's Hospital, Montreal, Quebec; Marie-Jose Clermont, Jean Guy Mongeau, Sean O'Regan, Pierre Robitaille, L'Hôpital Ste. Justine, Montreal, Quebec; John Crocker, Malcolm Ogborn, Izaak Walton Killam Hospital for Children, Halifax, Nova Scotia; Henry Gault, Patrick Parfrey, Michael Paul, Health Sciences Centre, Memorial University, St. John's Newfoundland.

    1

    Dr. Rowe is a Career Scientist of the Ministry of Health of Ontario.

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