Hemolytic-uremic syndrome: MedlinePlus Medical Encyclopedia

P Shiga-like toxin producing E coli hemolytic-uremic syndrome (STEC-HUS) is a disorder that most often occurs when an infection in the digestive system produces toxic substances. These substances destroy red blood cells and cause kidney injury.

T Causes
P Hemolytic-uremic syndrome (HUS) often occurs after a gastrointestinal infection with E coli bacteria (Escherichia coli O157:H7). However, the condition has also been linked to other gastrointestinal infections, including shigella and salmonella. It has also been linked to nongastrointestinal infections.
P HUS is most common in children. It is the most common cause of acute kidney failure in children. Several large outbreaks have been linked to undercooked hamburger meat contaminated with E coli.
P STEC-HUS is not to be confused with atypical HUS (aHUS) which is not infection-related. It is similar to another disease called thrombotic thrombocytopenic purpura (TTP).

T Symptoms
P STEC-HUS often begins with vomiting and diarrhea, which may be bloody. Within a week, the person may become weak and irritable. People with this condition may urinate less than normal. Urine output may almost stop.
P Red blood cell destruction leads to symptoms of anemia.
P Early symptoms:
- Blood in the stools
- Irritability
- Fever
- Lethargy
- Vomiting and diarrhea
- Weakness
P Later symptoms:
- Bruising
- Decreased consciousness
- Low urine output
- No urine output
- Pallor
- Seizures -- rare
- Skin rash that looks like fine red spots (petechiae)
- Yellow skin (jaundice)

T Exams and Tests
P The health care provider will perform a physical exam. This may show:
- Liver or spleen swelling
- Nervous system changes
P Laboratory tests will show signs of hemolytic anemia and acute renal failure. Tests may include:
- Blood clotting tests (PT and PTT)
- Comprehensive metabolic panel may show increased levels of BUN and creatinine
- Complete blood count (CBC) may show increased white blood cell count and decreased red blood cell count
- Platelet count is usually reduced
- Urinalysis may reveal blood and protein in the urine
- Urine protein test can show the amount of protein in the urine
P Other tests:
- Kidney biopsy
- Stool culture may be positive for a certain type of E coli bacteria or other bacteria

T Treatment
P Treatment may involve:
- Dialysis
- Medicines such as corticosteroids
- Transfusions of packed red blood cells and platelets

T Outlook (Prognosis)
P This is a serious illness in both children and adults, and it can cause death. With proper treatment, more than half of people will recover. The outcome is better in children than adults.

T Possible Complications
P Complications may include:
- Blood clotting problems
- Hemolytic anemia
- Kidney failure
- Nervous system problems
- Too few platelets (thrombocytopenia)
- Uremia

T When to Contact a Medical Professional
P Call your provider if you develop symptoms of HUS. Emergency symptoms include:
- Blood in the stool
- No urination
- Reduced alertness (consciousness)
P Call your provider if you have had an episode of HUS and your urine output decreases, or you develop other new symptoms.

T Prevention
P You can prevent the known cause, E coli, by cooking hamburger and other meats well. You should also avoid contact with unclean water.

T Alternative Names
P HUS; STEC-HUS

T Images
- Male urinary system

T References
P Abrams CS. Thrombocytopenia. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 172.
P Ruggenenti R, Cravedi P, Remuzzi G. Microvascular and macrovascular diseases of the kidney. In: Skorecki K, Chertow GM, Marsden PA, Taal MW, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 35.
P Van Why SK, Avner ED. Hemolytic-uremic syndrome. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 518.

T Review Date 2/1/2016
P Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

