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    Hemolytic-uremic syndrome

    HUS

    Hemolytic-uremic syndrome (HUS) is a disorder that usually occurs when an infection in the digestive system produces toxic substances that destroy red blood cells, causing kidney injury.

    Causes

    Hemolytic-uremic syndrome (HUS) often occurs after a gastrointestinal infection with E. coli bacteria (Escherichia coli O157:H7). However, the condition has also been linked to other gastrointestinal infections, including shigella and salmonella, as well as nongastrointestinal infections.

    HUS is most common in children. It is the most common cause of acute kidney failure in children. Several large outbreaks in 1992 and 1993 were linked to undercooked hamburger meat contaminated with E. coli.

    Other risk factors for HUS are unknown, although some cases are due to a familial form of the disease. HUS may occur with a variety of other diseases and infections, and after taking certain medications such as mitomycin C or ticlopidine.

    HUS is more complicated in adults. It is similar to another disease called thrombotic thrombocytopenic purpura (TTP).

    Symptoms

    HUS often begins with vomiting and diarrhea, which may be bloody. Within a week, the person may become weak and irritable. Persons with this condition may urinate less than normal. Urine output may almost stop.

    Red blood cell destruction leads to symptoms of anemia.

    Early symptoms:

    • Blood in the stools
    • Irritability
    • Fever
    • Lethargy
    • Vomiting and diarrhea
    • Weakness

    Later symptoms:

    • Bruising
    • Decreased consciousness
    • Low urine output
    • No urine output
    • Pallor
    • Seizures -- rare
    • Skin rash that looks like fine red spots (petechiae)
    • Yellow skin (jaundice)

    Exams and Tests

    The health care provider will perform a physical exam. This may show:

    • Liver or spleen swelling
    • Nervous system changes

    Laboratory tests will show signs of hemolytic anemia and acute renal failure. Laboratory tests may include:

    • Blood clotting tests (PT and PTT)
    • Comprehensive metabolic panel may show increased levels of BUN and creatinine
    • Complete blood count (CBC) may show increased white blood cell count and decreased red blood cell count
    • Platelet count is usually reduced
    • Urinalysis may reveal blood and protein in the urine
    • Urine protein test can be used to show the amount of protein in the urine

    Other tests:

    • Kidney biopsy
    • Stool culture may be positive for a certain type of E. coli bacteria or other bacteria

    Treatment

    Treatment may involve:

    • Dialysis
    • Medications such as corticosteroids
    • Transfusions of packed red blood cells and platelets

    Some people may have the liquid portion of their blood (plasma) removed and replaced with fresh (donated) plasma, or the plasma is filtered to remove antibodies from the blood.

    Outlook (Prognosis)

    This is a serious illness in both children and adults, and it can cause death. With proper treatment, more than half of patients will recover. The outcome is better in children than adults.

    Possible Complications

    • Blood clotting problems
    • Hemolytic anemia
    • Kidney failure
    • Nervous system problems
    • Too few platelets (thrombocytopenia)
    • Uremia

    When to Contact a Medical Professional

    Call your health care provider if you develop symptoms of HUS. Emergency symptoms include:

    • Blood in the stool
    • No urination
    • Reduced alertness (consciousness)

    Call your health care provider if you have had an episode of HUS and your urine output decreases, or you develop other new symptoms.

    Prevention

    You can prevent the known cause, E. coli, by cooking hamburger and meats well and avoiding contact with unclean water.

    References

    Abrams CS. Thrombocytopenia. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 175.

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          Tests for Hemolytic-uremic syndrome

          Review Date: 2/16/2012

          Reviewed By: Todd Gersten, MD, Hematology/Oncology, Palm Beach Cancer Institute, West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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