November 18, 2017

HUS Study Finds Nitrogen to Creatinine Ratio Accurate Predictor of Outcome

A study published in the European Journal of Pediatrics has found that blood urea nitrogen (BUN) to serum creatinine ratio is an accurate way to predict outcome in patients with diarrhea-associated hemolytic uremic syndrome (HUS), which is most often caused by ingesting Shiga toxin-producing E. coli (STEC). Identifying the tests that predict a poor outcome could help doctors intervene in a timely manner. The study looked at how accurately the BUN-to-sCreatinine ratio determined upon admission predicts patient outcome.

What is the BUN-to-sCreatinine ratio?

Attorney Fred Pritzker

Attorney Fred Pritzker and his infection litigation team are experts in litigation of E. coli-HUS cases. Pritzker and his team provide free consultations for families of HUS patients. You can reach him at 1-888-377-8900.

Blood urea nitrogen is a test that measures the amount of nitrogen in the blood from urea that is produced by the liver and filtered out of the blood by the kidneys. Serum creatinine is a waste product produced by muscle metabolism that is also filtered out of the blood by the kidneys. The BUN-sCreatinine ratio is indicator that shows how well the kidneys are working.

Normal BUN-t0-sCreatinine numbers are typically between 6 and 25 in adults. The number has not been definitively established in children, but we know that the numbers increase with age. The higher the number, the more indication that the kidneys are damaged, as it indicates that blood flow to the kidneys is compromised.

How did the researchers conduct their study?

Researchers searched records for children who were admitted to hospitals between January 1, 2008 and January 1, 2015 who were diagnosed with a “complicated course” of HUS or a poor outcome. A complicated course is defined as having pancreatitis, heart or lung involvement, and neurological dysfunction. A poor outcome is defined by the long-term development of chronic kidney disease or death.

What was the conclusion and what does it mean for patients with hemolytic uremic syndrome?

The risk of having a complicated course or a poor outcome was strongly associated with a  BUN-to-sCreatinine ratio equal to or less than 40 at admission. Another indicator of a poor outcome is higher serum creatinine and sLDH (serum lactic dehydrogenase) with a lower BUN-to-sCreatinine ratio. Hypertension, or high blood pressure, is another strong predictor of a poor outcome, as is oliguria, which is defined as very small amounts of urine production.

“With this information, doctors can quickly detect a child who is a high risk for serious complications from HUS,” said Fred Pritzker, noted food safety attorney. “An HUS patient admitted with a BUN-to-sCreatinine number of 40 or more should be carefully monitored and quickly treated to help improve outcome.”

About Fred Pritzker

Fred Pritzker is a national food safety attorney who has won millions for victims of E. coli-HUS. His team of experienced lawyers have filed lawsuits on behalf of clients sickened with E. coli infections and hemolytic uremic syndrome, a serious complication of that type of infection. E. coli infections can be linked to raw or undercooked meat, produce, raw milk and raw cider, and exposure to petting zoos. You can contact Fred and his team by filling out a free online consultation form.

Reference: Keenswijk, W., Vanmassenhove, J., Raes, A. et al. Eur J Pediatr (2017). doi:10.1007/s00431-016-2846-z

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