Hemolytic-uremic syndrome

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Background

Pathophysiology

  • Typical HUS is caused by Shiga toxin from enterohemorrhagic Escherichia coli (e.g. O157:H7)
  • Shiga toxin is absorbed systemically
    • Damages vascular endothelial cells leading to cytokine release and thrombus formation
    • Actives complement and binds Factor H (a complement regulator)

Risk Factors

  • Younger age
  • Exposure to antibiotics
  • Increased WBC count
  • Vomiting
  • Prolonged diarrhea
  • Presence of stx2a and eae genes

Clinical Manifestations

  • Abdominal pain and watery diarrhea about 4 days after exposure to toxin, progressing to bloody diarrhea with or without vomiting
    • Up to one third do not have bloody diarrhea
    • Fever is mild or absent
  • About 7 days after onset of diarrhea, HUS develops
  • Other preceding infections can include UTI, SSTI, or other causes of gastroenteritis

Management

  • Supportive