Pediatr Nephrol (2004) 19:1148–1152 DOI 10.1007/s00467-004-1516-y ORIGINAL ARTICLE María Gracia Caletti · Horacio Lejarraga · Diana Kelmansky · Mabel Missoni Two different therapeutic regimes in patients with sequelae of hemolytic-uremic syndrome Received: 3 November 2003 / Revised: 25 November 2003 / Accepted: 26 March 2004 / Published online: 18 June 2004  IPNA 2004 Abstract Renal disease is the most important long-term complication of hemolytic-uremic syndrome (HUS). A comparative study of renal function was carried out in two groups of patients. Group 1 included 19 children followed for a median of 11 years, 1960–1980, with a low-sodium diet, antihypertensive drugs, and a restricted protein intake in the end stage of renal disease. Group 2 included 26 children treated for a median of 9 years, 1988–2002, on a low-sodium diet, early restriction of protein intake ac- cording to recommendations, and angiotensin converting enzyme inhibitors (ACEi). Long-term renal function was assessed by the inverse of the plasma creatinine concen- tration (1/[Cr]) over time. Linear regression lines were fitted to individual values of 1/[Cr] for each child. Re- gression coefficients of children in group 1 were all neg- ative, ranging from 0.031 to 0.00043; 7 were signifi- cantly different from zero, indicating a linear fall in renal function over time. In contrast, children from group 2 had 11 negative slopes (only 1 significant) and 15 positive slopes, ranging from 0.17893 to 0.3899. Fisher’s exact test showed that group 1 had significantly more children with negative slopes than group 2. This comparatively better long-term outcome of renal function in children under contemporary treatment was probably associated with early restriction of protein and use of ACEi. Keywords Hemolytic-uremic syndrome · Chronic renal failure · Angiotensin converting enzyme inhibitors · Protein intake · Historical study Introduction Chronic renal disease is the most important long-term complication of hemolytic-uremic syndrome (HUS). In Argentina, 25%–30% of patients with HUS develop chronic renal disease that leads to progressive renal fail- ure [1, 2, 3, 4]. HUS is the second most frequent reason for renal transplant in this country [5, 6]. Treatment of the renal disease is the most important aspect of the care and follow-up of these children. From 1960 to 1980, and following the first descriptions of the syndrome [7, 8, 9], treatment consisted of a low-sodium diet and control of hypertension. Protein intake was strictly limited to 1 g/kg per day only in the final stages of renal failure. From 1980 major therapeutic changes were introduced that included strict restriction of protein intake according to the recommended dietary allowance (RDA) [10] and, more recently, administration of angiotensin converting enzyme inhibitors (ACEi). The long-term im- pact of this therapy on the development and progression of chronic renal failure (CRF) has not been assessed in children. Our team has taken care of children with renal disease secondary to HUS since 1960, and we have recorded in- formation for the period 1960–2002. The purpose of this retrospective study was to compare the long-term out- come of renal function of two groups of subjects: those who received contemporary treatment (ACEi, early pro- tein restriction, and low-sodium diet) and those treated during the period 1960–1980 (low-sodium diet, prazosin/ furosemide when indicated, and restricted protein intake when blood urea reached 100 mg/dl). M. G. Caletti · M. Missoni Nephrology Service, Garrahan Hospital, Combate de los Pozos 1881, 1245 Buenos Aires, Argentina H. Lejarraga Service of Growth and Development, Garrahan Hospital, Buenos Aires, Argentina D. Kelmansky Instituto del Cµlculo, Facultad de Ciencias Exactas, Universidad de Buenos Aires, Buenos Aires, Argentina M. G. Caletti ( ) ) Servicio de Nefrología, Hospital de Pediatría Juan P. Garrahan, Combate de los Pozos 1881, CP 1245, Buenos Aires, Argentina Tel.: +54-11-43084300 Fax: +54-11-43085325