Hemolytic-Uremic Syndrome Flashcards
What is HUS?
An acute syndrome, characterized by
- Microangiopathic hemolytic anemia
- Thrombocytopenia
- Severe renal failure.
HUS epidemiology?
Children
HUS is a genetic, life-threatening, chronic disease of… ?
Complement-mediated thrombotic microangiopathy
What is the etiology of renal injury in HUS?
Thrombin generation and inhibition of fibrinolysis lead to renal arteriolar and capillary microthrombi
What is the etiology of children in HUS?
Escherichia coli type 0157:H7
Leading cause of HUS
What are some common causes of HUS in adults and children?
Drugs
Infection
HIV
Pneumococcal infection
What is the clinical presentation of HUS?
Diarrhea - 90% Bloody Diarrhea - 75% Abdominal Pain Vomiting Fever Neurologic Hypertension Hepatomegaly Abnormal LFTs Anuria or oliguria Glucose intolerance and transient diabetes (10%)
What is diagnostic of HUS?
The triad of
- Thrombocytopenia
- Acute renal failure
- Microangiopathic hemolytic anemia
What will a peripheral smear show in HUS?
Anemia – (Hgb
What will platelet count show in HUS?
Thrombocytopenia (plts usually
What lab tests will be elevated in HUS?
Reticulocyte count
LDH
Indirect bilirubin
BUN/creat
What lab test will be low in HUS?
Haptoglobin
What lab test will be negative in HUS?
Coombs test
What will urinalysis show in HUS?
Proteinuria
Microscopic Hematuria
Pyuria
What will a stool culture show in HUS?
E. coli 0157:H7
(+) in > 90% during first week of illness
After 1st wk, only 30% are (+)
What is treatment for severe anemia?
Blood transfusions
What treatment options should be avoided in treatment of HUS?
Antibiotics
Antimotility agents
What is Eculizumab?
A monoclonal antibody toward C5, is approved in adults for tx of atypical HUS
Trials show effectiveness inhibiting complement-mediated thrombotic microangiopathy
What is included in acute needs in HUS treatment?
HTN
Seizure control
What is included in chronic needs in HUS treatment?
Dialysis may be required for anuric or oliguric renal failure
What is the prognosis in patients with HUS?
Adults with HUS have a worse prognosis than do children
Mortality rate is
What is important to know for kids testing (+) for the E.coli serotype?
They should not return to school or day care facilities until 2 consecutive stools test (-) for the organism.
