Hemolytic-uremic syndromeHUS; STEC-HUS; Hemolytic-uremic syndrome
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.
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.
Shigellosis is a bacterial infection of the lining of the intestines. It is caused by a group of bacteria called shigella.Read Article Now Book Mark Article
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 Article
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.
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 Article
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 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 Article
- Blood in the stools
- Vomiting and diarrhea
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up is forcing the contents of the stomach ...Read Article Now Book Mark Article
- Decreased consciousness
- Low urine output
- No urine output
- Seizures -- rare
- Skin rash that looks like fine red spots (petechiae)
Exams and Tests
The health care provider will perform a physical exam. This may show:
- Liver or spleen swelling
- Nervous system changes
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
Acute 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)
Prothrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot. A related blood test is ...Read Article Now Book Mark Article
- 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...Read Article Now Book Mark Article
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 ...Read Article Now Book Mark Article
- 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
- Stool culture may be positive for a certain type of E coli bacteria or other bacteria
- Kidney biopsy (in rare cases)
Treatment may involve:
- Medicines, such as corticosteroids
- Management of fluids and electrolytes
- Transfusions of packed red blood cells and platelets
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.
Complications may include:
- Blood clotting problems
- Hemolytic anemia
- Kidney failure
- Hypertension leading to seizures, irritability, and other nervous system problems
- Too few platelets (thrombocytopenia)
When to Contact a Medical Professional
Call your provider if you develop symptoms of HUS. Emergency symptoms include:
- Blood in the stool
- No urination
- Reduced alertness (consciousness)
Call your provider if you have had an episode of HUS and your urine output decreases, or you develop other new symptoms.
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.
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.
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.
Schneidewend R, Epperla N, 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. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 134.
Review Date: 2/6/2020
Reviewed 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, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.