Basic Fibroblast Growth Factor among Children with Diarrhea-Associated Hemolytic Uremic Syndrome

Diarrhea-associated hemolytic uremic syndrome (DHUS) is characterized by endothelial injury and activation of inflammatory cytokines. Basic fibroblast growth factor (bFGF) is an angiogenic peptide released in response to vas- cular damage. The plasma concentrations and urinary excretion of bFGF during the course of DHUS were determined, in comparison with the levels of various inflammatory cytokines, and changes were correlated with clinical and laboratory fea- tures of the disease. Serial plasma and urine samples were collected from 31 children with DHUS, during the acute (days 1 to 7 of hospitalization) and recovery (through day 60 after discharge from the hospital) phases of the disease. The patients were enrolled in the multicenter trial of SYNSORB Pk (SYNSORB Biotech, Calgary, Alberta, Canada) treatment for DHUS. bFGF, interleukin-1 (IL-1), IL-8, and tumor ne- crosis factor- levels were determined with enzyme-linked immunosorbent assays. bFGF was detected in urine and plasma samples more frequently than were IL-1, IL-8, and tumor necrosis factor-. There was an acute increase in urinary bFGF excretion, which returned to normal during convalescence. Urinary excretion of bFGF during the acute phase was higher among patients who required dialysis, compared with those who did not (48.9 15.0 and 28.9 9.0 pg/ml, respectively; P 0.05). Plasma bFGF concentrations were persistently elevated throughout the period of hospitalization and the fol- low-up period among patients with DHUS. Urinary excretion and plasma levels of bFGF were comparable for the SYN- SORB Pk-treated (n 19) and placebo-treated (n 12) groups. Measurements of urinary and plasma concentrations of bFGF among patients with DHUS may be useful indices for assessment of the severity of acute renal disease and the timing and adequacy of the systemic angiogenic process during early convalescence.