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Purpose. To analyze the epidemiological, clinical, and laboratory characteristics of hemolytic-uremic syndrome (HUS) in Uberlandia, MG, Brazil. Methods. A historical cohort study was performed encompassing a ten-year period from January 1994 to January 2004 in the Department of Pediatric Nephrology at a full-service hospital; demographic factors, triggering factors, time of hospitalization, supportive therapy, and disease progression were analyzed. Results. Twenty-seven children aged 5 to 99 months (median age of 14 months) were studied; 70.4% were male. Of the 27 patients, 77.8% were from urban areas and 18.5% were from rural areas. Eight of the patients (29.6%) were reported to drink raw milk, and clinical diarrhea was reported in 81.5% of cases. The most common signs and symptoms were fever and vomiting (85.1%), anuria (63.0%), seizure (33.0%), cardiac involvement (11.0%), and acute pulmonary edema (7.4%). Dialysis was performed on 20 patients (74%). The mean hospital stay was 24 days (range: 13 to 36 days). While monitoring the patients, 2 died (7.4%), 3 developed chronic kidney disease (11.0%), and 21 (77.8%) developed hypertension. Conclusion. Our results emphasize the possibility of diagnosing HUS as a cause of renal failure in childhood in both typical (postdiarrheal) and atypical forms and suggest that an investigation of the etiological agent should be made whenever possible.
RESUMO
OBJECTIVE: To test the hypothesis that overweight adolescents have higher plasma total homocysteine (tHcy) levels than non-overweight adolescents and to explore the association between plasma tHcy levels with folate, vitamin B12 and some risk factors for CVD in both groups. METHODS: A case-control study conductec with 239 adolescentes aged 15-19 years in the city of São Paulo, Brazil; 86 overweight and 153 non-overweight frequency matched by age, gender, pubertal and socioeconomic status. tHcy, folate, vitamin B12, lipid profile, glucose, insulin and insulin resistance were measured. RESULTS: No significant differences were found in tHcy, folate and vitamin B12 levels between overweight and non-overweight groups. The geometric means of tHcy were elevated in both groups (overweight: 11.8 micromol/L; non-overweight: 11.6 micromol/L) higher for boys than for girls (P < or = 0.001). Folate deficiency was identified in 68.6% of total studied population. Triacylglycerol, LDL cholesterol, insulin resistance were higher and HDL cholesterol was lower in overweight that non-overweight adolescents. In the multiple linear regression model, in overweight group, tHcy was independently associated with age (P = 0.041), sex (P = 0.004) and folate (P = 0.022) and in non-overweight group, with age (P = 0.049), sex (P < 0.001), folate (P = 0.018) and vitamin B12 (P = 0.030). CONCLUSIONS: Obesity was not a determinant factor of tHcy levels. Age, sex and folate were independent determinants of plasma tHcy levels. The high prevalence of folate deficiency may have been responsible for the elevated tHcy levels in these adolescents, increasing the risk for future development of CVD.