Hemolytic uremic syndrome

Characterized by microangiopathic hemolytic anemia, thrombocytopenia, and nephropathy.

Most cases are in children and are related to epidemic gastroenteritis caused by verotoxin-producing Escherichia coli.

Seen in adults in a sporadic form, which is difficult to distinguish from thrombotic thrombocytopenic purpura (TTP).

Can result in renal failure or renal insufficiency necessitating dialysis, or renal transplant if irreversible renal failure.

Adequate hydration important to minimize renal damage. Avoidance of antibiotics, antimotility agents, narcotic opioids, nonsteroidal anti-inflammatory drugs, and platelet transfusions is advised. Plasma exchange is used in adults and cases of sporadic and secondary HUS.

Anemia can be treated with red cell transfusion. Calcium-channel blockers are preferred for treatment of hypertension.

Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and nephropathy. Ninety percent of cases occur in the pediatric population, related to outbreaks of gastroenteritis caused by verotoxin-producing Escherichia coli.[1]Mead PS, Griffin PM. Escherichia coli O157:H7. Lancet. 1998;352:1207-1212. http://www.ncbi.nlm.nih.gov/pubmed/9777854?tool=bestpractice.com In adults a sporadic form is seen, which is difficult if not impossible to distinguish from thrombotic thrombocytopenic purpura.[2]George JN. How I treat patients with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Blood. 2000;96:1223-1229. http://bloodjournal.hematologylibrary.org/cgi/reprint/96/4/1223 http://www.ncbi.nlm.nih.gov/pubmed/10942361?tool=bestpractice.com It is a result of endothelial cell damage causing microvascular thrombosis.