HUS:
-One of the most common causes for acute renal failure in children
-Mean age of presentation is between 3-5 years of age
Associated infections:
–E. Coli 0157:H7 is the most common
-Shigella, S. pneumonia, and certain drugs are also associated with causing HUS
Concept of the Disease
-Fibrin strands form along blood vessels causing microangiopathic hemolytic anemia
-Renal dysfunction occurs directly from injury to the renal vasculature, as well as from platelet/complement deposit in the glomerular lumen.
Symptoms:
-Prodromic gastroenteritis: Abdominal pain, bloody diarrhea
-Later effects: Thrombocytopenia, microangiopathic hemolytic anemia, renal failure
Prognosis:
-Up to 25% of patients had long term renal injury
-Up to 12% of patients develop end stage renal disease or even death
-Recurrences are a possibility with a high mortality (up to 30%)
Treatment:
–Gentle fluid resuscitation and supportive care
-Treatment of hyperkalemia when present
–Transfusions as needed (platelet transfusions are reserved only in cases of bleeding)
-Antibiotics are not recommended for the gastroenteritis as they have been associated with increased release of verotoxin possibly increasing the risk for HUS
–Plasmapharesis can be considered in severe cases
Submitted by Joey Grover.
References: Rosen’s Emergency Medicine: 7th Edition. picture
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