Hemolytic Uremic Syndrome

25 Apr

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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