Hemolytic-uremic syndromeHUS; STEC-HUS
Shiga-like toxin producing E coli hemolytic-uremic syndrome (STEC-HUS) is a disorder that most often occurs when an infection in the digestive system produces toxic substances. These substances destroy red blood cells and cause kidney injury.
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. It has also been linked to nongastrointestinal infections.
Shigellosis is an infection of the lining of the intestines. It is caused by a group of bacteria called shigella.
Salmonella enterocolitis is an infection in the lining of the small intestine that is caused by salmonella bacteria. It is a type of food poisoning....
HUS is most common in children. It is the most common cause of acute kidney failure in children. Several large outbreaks have been linked to undercooked hamburger meat contaminated with E coli.
STEC-HUS is not to be confused with atypical HUS (aHUS) which is not infection-related. It is similar to another disease called thrombotic thrombocytopenic purpura (TTP).
Thrombotic thrombocytopenic purpura
Thrombotic thrombocytopenic purpura (TTP) is a blood disorder that causes blood clots to form in small blood vessels. This leads to a low platelet c...
STEC-HUS often begins with vomiting and diarrhea, which may be bloody. Within a week, the person may become weak and irritable. People with this condition may urinate less than normal. Urine output may almost stop.
Red blood cell destruction leads to symptoms of anemia.
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different type...
- Blood in the stools
- Vomiting and diarrhea
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up is forcing the contents of the stomach ...
- Decreased consciousness
- Low urine output
- No urine output
- 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
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Normally, red ...
Acute renal failure
Acute kidney failure is the rapid (less than 2 days) loss of your kidneys' ability to remove waste and help balance fluids and electrolytes in your b...
- Blood clotting tests (PT and PTT)
Prothrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot. A related blood test is ...
- Comprehensive metabolic panel may show increased levels of BUN and creatinine
Comprehensive metabolic panel
A comprehensive metabolic panel is a group of blood tests. They provide an overall picture of your body's chemical balance and metabolism. Metaboli...
BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down. A test can be done to measure the amount of urea nitrogen ...
- 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 show the amount of protein in the urine
Treatment may involve:
- Medicines such as corticosteroids
- Transfusions of packed red blood cells and platelets
This is a serious illness in both children and adults, and it can cause death. With proper treatment, more than half of people will recover. The outcome is better in children than adults.
Complications may include:
- Blood clotting problems
- Hemolytic anemia
- Kidney failure
- Nervous system problems
- Too few platelets (thrombocytopenia)
When to Contact a Medical Professional
Call your provider if you develop symptoms of HUS. Emergency symptoms include:
- Blood in the stool
- No urination
- Reduced alertness (consciousness)
Call your provider if you have had an episode of HUS and your urine output decreases, or you develop other new symptoms.
You can prevent the known cause, E coli, by cooking hamburger and other meats well. You should also avoid contact with unclean water.
Abrams CS. Thrombocytopenia. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 172.
Ruggenenti R, Cravedi P, Remuzzi G. Microvascular and macrovascular diseases of the kidney. In: Skorecki K, Chertow GM, Marsden PA, Taal MW, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 35.
Van Why SK, Avner ED. Hemolytic-uremic syndrome. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 518.
Review Date: 2/1/2016
Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.