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Hemolytic Uremic Syndrome

 Syn. HUS

Signs & Symptoms

 Diarrhea
Note: due to Bacterial Gastroenteritis, due to Gastrointestinal tract involvement
Ref: Uptodate [ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 2164] Cecil [ 319] Epocrates [ https://online.epocrates.com/diseases/47033/Hemolytic-uremic-syndrome/History-Exam]
Generalized malaise
Note: due to Microangiopathic hemolytic anemia, due to MAHA
Ref: Uptodate [ Diagnostic approach to suspected TTP, HUS, or other thrombotic microangiopathy (TMA)/ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 1182]
Acute kidney failure #criteria
Note: Some levels of kidney involvment with different intensity
Ref: Uptodate [ Diagnostic approach to suspected TTP, HUS, or other thrombotic microangiopathy (TMA)/ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 827/ 2099] Cecil [ 293/ 319]
Acute kidney injury #criteria
Note: Some levels of kidney involvement with different intensity
Ref: Uptodate [ Diagnostic approach to suspected TTP, HUS, or other thrombotic microangiopathy (TMA)/ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 827/ 2099] Cecil [ 293/ 319]

Physical Examination

 Pallor
Note: due to Microangiopathic hemolytic anemia, due to MAHA
Ref: Uptodate [ Diagnostic approach to suspected TTP, HUS, or other thrombotic microangiopathy (TMA)/ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 1182]
Hypertention
Note: due to Acute kidney injury, due to Cardiac dysfunction, due to alterations of sodium excretion
Ref: Uptodate [ Diagnostic approach to suspected TTP, HUS, or other thrombotic microangiopathy (TMA)/ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 292]
significantly elevated blood pressure (negative symptom)
Ref: Epocrates [ https://online.epocrates.com/diseases/47034/Hemolytic-uremic-syndrome/Diagnostic-Tests]

Lab / Serology

 Low Hemoglobin
Note: due to Microangiopathic hemolytic anemia, due to MAHA
Ref: Uptodate [ Diagnostic approach to suspected TTP, HUS, or other thrombotic microangiopathy (TMA)/ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 1182] Cecil [ 319]
Elevated reticulocyte count
Note: due to Erythropoiesis
Ref: Uptodate [ Diagnostic approach to suspected TTP, HUS, or other thrombotic microangiopathy (TMA)/ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Cecil [ 319]
Increased indirect Bilirubin
Note: due to Microangiopathic hemolytic anemia, due to MAHA
Ref: Uptodate [ Diagnostic approach to suspected TTP, HUS, or other thrombotic microangiopathy (TMA)/ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children]

Imagin Study

Complication

 End Stage Renal Disease
Note: due to Acute kidney injury,note to 50% of atypical cases progress to ESRD. ESRD due to HUS is more common in adult patients,note to Some levels of kidney involvement with different intensity.
Ref: Uptodate [ Diagnostic approach to suspected TTP, HUS, or other thrombotic microangiopathy (TMA)/ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 707] Cecil [ 296]
Chronic kidney disease
Note: Some levels of kidney involvement with different intensity
Ref: Uptodate [ Diagnostic approach to suspected TTP, HUS, or other thrombotic microangiopathy (TMA)/ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children]
Agraphia
Ref: Uptodate [ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 2164 / 2081] Cecil [ 294 / 319]

Risk Factors

 Children
Ref: Cecil [ 319]

Cause

 Shiga-toxin-producing enteroaggregative Escherichia coli #Typical_HUS
Note: due to Shiga toxin,note to (Bacteria), Generally the main cause of HUS is Shiga Toxin-producing Escherichia coli (STEC)
Ref: Uptodate [ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 827 / 718 / 962] Cecil [ 294 / 319]
Enterohemorrhagic Escherichia coli #Typical_HUS
Note: due to Shiga toxin, note to (Bacteria), Generally the main cause of HUS is Shiga Toxin-producing Escherichia coli (STEC)
Ref: Uptodate [ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 827 / 718 / 962] Cecil [ 294 / 319]
Shiga Toxin-producing Escherichia coli #Typical_HUS
Note: due to Shiga toxin,note to (Bacteria), Generally the main cause of HUS is Shiga Toxin-producing Escherichia coli (STEC)
Ref: Uptodate [ Clinical manifestations and diagnosis of Shiga toxinproducing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children] Harrison [ 827 / 718 / 962] Cecil [ 294 / 319]

Other