Hemolytic-uremic syndrome
HUS; STEC-HUS; Hemolytic-uremic syndromeShiga-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.
Causes
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 non-gastrointestinal infections.
Shigella
Shigellosis is a bacterial infection of the lining of the intestines. It is caused by a group of bacteria called Shigella.
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Salmonella enterocolitis is a bacterial infection in the lining of the small intestine that is caused by Salmonella bacteria. It is a type of food p...
Read Article Now Book Mark ArticleHUS 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.
E coli can be transmitted through:
- Contact from one person to another
- Consuming uncooked food, such as milk products or beef
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).
Thrombotic thrombocytopenic purpura
Thrombotic thrombocytopenic purpura (TTP) is a blood disorder in which platelet clumps form in small blood vessels. This leads to a low platelet cou...
Read Article Now Book Mark ArticleSymptoms
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.
Red blood cell destruction leads to symptoms of anemia.
Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different type...
Read Article Now Book Mark ArticleEarly symptoms:
-
Blood in the stools
Blood in the stools
Black or tarry stools with a foul smell are a sign of a problem in the upper digestive tract. It most often indicates that there is bleeding in the ...
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-
Fever
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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Lethargy
Lethargy
Fatigue is a feeling of weariness, tiredness, or lack of energy.
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Vomiting and diarrhea
Vomiting
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
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Later symptoms:
-
Bruising
Bruising
Bleeding into the skin can occur from broken blood vessels that form tiny red dots (called petechiae). Blood also can collect under the tissue in la...
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Decreased consciousness
Decreased consciousness
Decreased alertness is a state of reduced awareness and is often a serious condition. A coma is the most severe state of decreased alertness from whi...
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Low urine output
Low urine output
Decreased urine output means that you produce less urine than normal. Most adults make at least 500 milliliters of urine in 24 hours (a little over ...
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-
Pallor
Pallor
Paleness is an abnormal loss of color from normal skin or mucous membranes.
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Seizures -- rare
Seizures
A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...
Read Article Now Book Mark Article - Skin rash that looks like fine red spots (petechiae)
Petechiae
Bleeding into the skin can occur from broken blood vessels that form tiny red dots (called petechiae). Blood also can collect under the tissue in la...
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Exams and Tests
Your health care provider will perform a physical exam. This may show:
- Liver or spleen swelling
- Nervous system changes
Laboratory tests will show signs of hemolytic anemia and acute renal failure. Tests may include:
Hemolytic anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Normally, red ...
Read Article Now Book Mark ArticleAcute renal failure
Acute kidney failure is the rapid (less than 2 days) loss of your kidneys' ability to remove waste and help balance fluids and electrolytes in your b...
Read Article Now Book Mark Article- Blood clotting tests (PT and PTT)
PT
Prothrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot. It measures the functio...
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Partial thromboplastin time (PTT) is a blood test that looks at how long it takes for blood to clot. It can help tell if you have a bleeding problem...
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Comprehensive metabolic panel may show increased levels of BUN and creatinine
Comprehensive metabolic panel
A comprehensive metabolic panel is a group of blood tests. They provide an overall picture of your body's chemical balance and metabolism. Metaboli...
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BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down. A test can be done to measure the amount of urea nitrogen ...
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The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys are working. Creatinine in t...
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Complete blood count (CBC) may show increased white blood cell count and decreased red blood cell count
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
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Platelet count is usually reduced
Platelet count
A platelet count is a lab test to measure how many platelets you have in your blood. Platelets are particles in the blood that help the blood clot. ...
Read Article Now Book Mark Article - Review of a blood smear, which shows deformed and fragmented red blood cells
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Urinalysis may reveal blood and protein in the urine
Urinalysis
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...
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Urine protein test can show the amount of protein in the urine
Urine protein
The urine protein dipstick test measures the presence of all proteins, including albumin, in a urine sample. Albumin and protein can also be measured...
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Other tests:
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Stool culture may be positive for a certain type of E coli bacteria or other bacteria
Stool culture
A fecal culture is a lab test to find organisms in the stool (feces) that can cause gastrointestinal symptoms and disease.
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Colonoscopy
Colonoscopy
A colonoscopy is an exam that views the inside of the colon (large intestine) and rectum, using a tool called a colonoscope. The colonoscope has a sm...
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Kidney biopsy (in rare cases)
Kidney biopsy
A kidney biopsy is the removal of a small piece of kidney tissue for examination.
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Treatment
Treatment may involve:
- Dialysis
- Medicines, such as corticosteroids
- Management of fluids and electrolytes
- Transfusions of packed red blood cells and platelets
Outlook (Prognosis)
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.
Possible Complications
Complications may include:
- Blood clotting problems
-
Hemolytic anemia
Hemolytic anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Normally, red ...
Read Article Now Book Mark Article - Kidney failure
- Hypertension leading to seizures, irritability, and other nervous system problems
- Too few platelets (thrombocytopenia)
Thrombocytopenia
Thrombocytopenia means there is an abnormally low amount of platelets. Platelets are parts of the blood that help blood to clot. This condition is ...
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Uremia
Uremia
Prerenal azotemia is an abnormally high level of nitrogen waste products in the blood.
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When to Contact a Medical Professional
Contact your provider if you develop symptoms of HUS. Emergency symptoms include:
- Blood in the stool
- No urination
- Reduced alertness (consciousness)
Contact your provider if you have had an episode of HUS and your urine output decreases, or you develop other new symptoms.
Prevention
You can prevent the known cause, E coli, by cooking hamburger and other meats well. You should also avoid contact with unclean water and follow proper hand washing methods.
References
Alexander T, Licht C, Smoyer WE, Rosenblum ND. Diseases of the kidney and upper urinary tract in children. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap: 72.
George G, Friedman KD. Thrombotic thrombocytopenic purpura and the hemolytic uremic syndromes. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 132.
Mele C, Noris M, Remuzzi G. Hemolytic uremic syndrome. In: Ronco C, Bellomo R, Kellum JA, Ricci Z, eds. Critical Care Nephrology. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 50.
Review Date: 3/31/2024
Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.