| Hemolytic uremic syndrome (HUS) is a disorder that usually causes microangiopathic hemolytic anemia (destruction of red blood cells in small and medium sized blood vessels), thrombocytopenia (a low platelet count), and acute renal failure. It is the most common cause of acute renal failure in infants and children and there are about 2-4 cases per 100,000 children in the United States, usually during the summer and early fall.
HUS most commonly affects kids between the ages of six months and four years of age, who usually have the classic or epidemic form of HUS, which is preceded by diarrhea for 3-4 days. The diarrhea is usually watery and may be bloody and associated with vomiting and/or abdominal pain. The diarrhea can last up to 12 days and is most commonly caused by eating meat that is contaminated with the E coli 0157 bacteria (although it can also be caused by other bacteria or by a non-diarrhea associated form).
As the diarrhea improves, the child may then become pale because of the development of anemia, and irritable. As the renal failure progresses, affected children will stop urinating and will develop signs of fluid overload, with edema or swelling, high blood pressure, and difficulty breathing. He may also become more irritable or lethargic and may develop seizures.
Testing will include a complete blood count, with will show the anemia and low platelet counts. Other blood tests will include a creatinine to see how the kidneys are functioning and measurement of electrolytes, which may show a low sodium (hyponatremia), high potassium (hyperkalemia) and an increased level of acid in the blood (acidosis). Culture of the stool may grow the E coli 0157 bacteria.
Treatments for hemolytic uremic syndrome depend on the severity of anemia and renal failure and may include careful management of how much fluid your child receives, blood transfusions, and dialysis, including peritoneal dialysis if possible. Treatments may also include control of high blood pressure, platelet transfusions, but will probably not include the use of antibiotics.
Over 90% of affected children recover, and with recovery, the platelet count will begin to return to normal, urine output will increase and the red blood counts will slowly return to normal.
Most children with hemolytic uremic syndrome should be treated by a Pediatric Nephrologist.
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