Hemolytic uremic syndrome - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Hemolytic uremic syndrome (HUS) is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury.
Most cases of HUS occur in children and are diarrhea-associated (D+ HUS). Diarrhea-associated HUS is usually caused by Shiga toxin-producing Escherichia coli.
Rarely other organisms, such as Shigella and Streptococcus pneumoniae, are implicated.
Acute kidney injury necessitating dialysis develops in approximately half of children with diarrhea-associated HUS.
Adequate hydration is important to minimize renal damage in HUS associated with Shiga toxin-producing E coli infections. Avoidance of antibiotics, antimotility agents, and nonsteroidal anti-inflammatory drugs is advised. Cautious use of opioids is advised; there are insufficient data on the effect of opioids on the course of HUS.

Peripheral smear with numerous fragmented erythrocytes

From the personal collection of Dr A. Zimrin; used with permission

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Peripheral smear with numerous fragmented erythrocytes

Citations

Key Articles

Fakhouri F, Zuber J, Frémeaux-Bacchi V, et al. Haemolytic uraemic syndrome. Lancet. 2017 Aug 12;390(10095):681-96.[Abstract]
Banatvala N, Griffin PM, Greene KD, et al. The United States national prospective hemolytic uremic syndrome study: microbiologic, serologic, clinical and epidemiologic findings. J Infect Dis. 2001 Apr 1;183(7):1063-70.[Abstract]
Tarr PI, Gordon CA, Chandler WL. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet. 2005 Mar 19-25;365(9464):1073-86.[Abstract]
Wong CS, Jelacic S, Habeeb RL, et al. The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med. 2000 Jun 29;342(26):1930-6.[Abstract][Full Text]
McKee RS, Schnadower D, Tarr PI, et al; Pediatric Emergency Medicine Collaborative Research Committee and Pediatric Emergency Research Canada. Predicting hemolytic uremic syndrome and renal replacement therapy in Shiga toxin-producing Escherichia coli-infected children. Clin Infect Dis. 2020 Apr 10;70(8):1643-51.[Abstract][Full Text]
Loirat C, Fakhouri F, Ariceta G, et al; HUS International. An international consensus approach to the management of atypical hemolytic uremic syndrome in children. Pediatr Nephrol. 2016 Jan;31(1):15-39.[Abstract]
Boyce TG, Swerdlow DL, Griffin PM. Escherichia coli O157:H7 and the hemolytic uremic syndrome. N Engl J Med. 1995 Aug 10;333(6):364-8.[Abstract]
Rathbone J, Kaltenthaler E, Richards A, et al. A systematic review of eculizumab for atypical haemolytic uraemic syndrome (aHUS). BMJ Open. 2013 Nov 4;3(11):e003573.[Abstract][Full Text]

Referenced Articles

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