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HWN Suggests

Hemolytic Uremic Syndrome (HUS): Pearls and Pitfalls

In a pediatric patient presenting with abdominal pain and diarrhea, HUS is not often considered at the top of the initial differential diagnosis. The diagnosis can be further complicated as the patient may present without bloody diarrhea and may not even develop bloody diarrhea. The main differential diagnoses to consider in the early stage, before the classic triad of anemia, thrombocytopenia, and acute kidney injury has developed, include other infectious causes of diarrhea. These include Salmonella, Shigella, Campylobacter, Yersinia, Amebiasis, and Clostridium Difficile, all of which can cause abdominal pain, bloody diarrhea, leukocytosis, and fever. The key differentiating factor is that…

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 Misconceptions Regarding Hemolytic Uremic Syndrome

The following common misconceptions regarding HUS are debunked, and emergency department (ED) physicians should maintain a high index of suspicion for HUS in ill-appearing children with signs of dehydration.

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MAHA, TTP, HUS, DIC... Oh My! Understanding Microangiopathic Hemolytic Anemias

TTP, HUS, and DIC are emergent, potentially life-threatening conditions, and should be treated as such. While the specific treatments for these conditions differ, supportive care is universal to all the conditions.

EM@3AM – Hemolytic Uremic Syndrome

Do not administer anti-motility agents (risk of toxic megacolon) or antibiotics if etiology is believed to be E.coli O157:H7 (enhances release of toxin). Primary HUS => treated with eculizumab: monoclonal anti-C5 antibody that targets a downstream mediator in the complement cascade.

Hemolytic Uremic Syndrome Is Rare but Serious Complication of E. Coli Infection

This case highlights the importance of recognizing the symptoms of HUS. HUS is a serious complication resulting from E. coli infection, most often with Shiga toxin–producing E. coli (STEC). The toxins produced by STEC activate the endothelium, create a prothrombotic state, and lead to inflammation. E. coli 0157 is the most common strain of STEC in the United States and accounts for more than 90 percent of HUS cases in children under 5 years of age. About 5 percent to 15 percent of people infected with STEC develop HUS.

Hemolytic uremic syndrome: Search for the best treatment regimen with one of the world's most expansive medications

Hemolytic uremic syndrome (HUS) is a severe illness that may lead to a complete loss of renal function. Most of the HUS cases are caused by infection with the shiga-toxin-producing Escherichia coli, well known from the 2011 epidemic in Germany, which resulted in 845 documented HUS cases and 54 deaths. A rare, but more severe atypical form of HUS (aHUS) is not caused by the infection, but occurs spontaneously with over 50 percent of cases progressing to end stage renal disease. This form of the disease is caused by the attack of the body's own complement system on the capillary lining (endothelium) of glomeruli in the kidney.

Hemolytic Uremic Syndrome: “HUS, it’s what’s for dinner"

Hemolytic uremic syndrome (HUS) is a clinical syndrome characterized by an acute kidney injury with associated microangiopathic hemolytic anemia and thrombocytopenia.1 Infection with Shiga toxin-producing E. coli (also known as STEC) is the most common cause of HUS in the pediatric population, accounting for up to 90% of all cases in children under the age of five.

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Core EM

There is conflicting evidence concerning whether the use of antibiotics in patients with STEC infection can precipitate HUS; such use is generally not recommended. Antimotility agents are contraindicated in children with HUS because of the risk of developing toxic megacolon

Life in the Fastlane

Supportive care and monitoring are the mainstays: antibiotics may worsen toxin production, platelets are contra-indicated, plasmapheresis if unsure, seek and treat the underlying cause and any complications. TTP has predominantly neurological features, in HUS renal failure predominates.

PICUDoconCall

Antibiotics are contraindicated as they can cause HUS as well as favor release of Shiga Toxin, or provide selection pressure if the organism is not fully eliminated.