Hemolytic uremic syndrome

Background

• Similar to but different from TTP (which is more common in adults)

• Triad of:
  • Acute renal failure, thrombocytopenia, microangiopathic hemolytic anemia
• Most common cause of ARF in children
  • Most common in children <10yr (2/3 of cases in <5yr)
• Most common cause is E. coli O157:H7 infection

Diagnosis

Presentation

• E. coli enteritis
  • N/V, bloody diarrhea
  • Within a week develops pallor, oliguria, lethargy, sz, encephalopathy

Work-Up

• CBC
  • WBC may be elevated
  • Anemia
    • Schistocytes, helmet/burr cells
  • Thrombocytopenia
• Stool tests
  • Shiga toxin, E. coli O157:H7 test
• UA
  • Hematuria, casts
• Bilirubin (hemolysis)
• Chemistry
  • Hyperkalemia (renal failure)

DDx

• Acute gastroenteritis
• Appendicitis
• Colitis
• Intussusception
• IBD
• Perforation
• DIC
• TTP
• SLE

Treatment

• Supportive
  • Fluid for hypovolemia, transfusion for anemia
• Antibiotics are not indicated
• Platelets are contraindicated
• Emergency dialysis if indicated

Disposition

Admit all

Source

Tintinalli