Haemolytic Uraemic syndrome
Haemolytic Uraemic syndromes: Hemolytic Uremic syndromes (USA)
The haemolytic uraemic syndromes (HUS) are a group of disorders that can lead to acute kidney failure in children. These conditions are characterised by haemolytic anaemia (destruction of red blood cells) a low platelet count and kidney failure. There are three types of HUS: one caused by Escherichia coli (E.coli), one caused by the Pneumococcus bug and an atypical form.
Medical text written July 2011 by Dr R Trompeter, Consultant Paediatric Nephrologist, Great Ormond Street Hospital, London, UK.
HUS caused by E.Coli, the child will have had a preceding episode of diarrhoea, which is usually bloody. For this reason it is sometimes call diarrhoea positive (D+) HUS. When HUS is caused by the Pneumococcal bug, the child may have had a chest infection.
Symptoms include paleness, tiredness and weakness – which are all indicative of anaemia. A child may pass less urine or stop passing urine completely. This means that the kidneys are unable to remove excess salt and water from the body, which can lead to swollen face, tummy, hands or feet (oedema), and hypertension (raised blood pressure). Other organ systems may be affected and there may be signs of neurological involvement.
Most children develop HUS after a preceding illness, usually gastroenteritis. The onset of the breakdown of red blood cells and kidney failure is sudden.
It is now believed that the majority of cases of D+HUS are associated with infection by verocytotoxin producing Escherichia coli (VTEC). These organisms are associated with clinical conditions ranging from mild diarrhoea to haemorrhagic colitis and D+HUS. Food-borne transmission of VTEC 0157 has been shown to occur in a large number of outbreaks in various parts of the world. Minced beef and dairy produce are the most commonly implicated foods. Infection has also been associated with the consumption of water, vegetables and fruit juice. Person to person spread and contact with livestock have also been documented as modes of transmission of infection in outbreaks in Europe and North America.
Dehydration is common after severe vomiting and diarrhoea and can be treated by giving fluids through a drip. Regular blood tests will be needed to check the levels red blood cells and platelets. A blood transfusion may be required if a child has a very low level of red blood cells.
When kidneys are severely affected kidney dialysis may be required. Sometimes children are left with kidneys that do not recover completely and have chronic renal failure. In this case, prolonged dialysis may be needed.
Typical HUS once treated does not tend to return, however, it is advised that children who have had an episode be kept under general medical review. Atypical HUS tends to come and go after treatment, so careful follow-up is necessary.
Haemolytic Uraemic Syndrome Help (HUSH)
HUSH is a Registered Charity in Scotland No. SC026945. It supports and brings together families affected by E.coli O157 in the UK. The Charity increases public awareness of E.coli O157 and provides information on avoiding infection.
Group details last updated December 2014.