Hemolytic Uremic Syndrome in Children

What is hemolytic uremic syndrome (HUS)?

HUS is a rare condition that can lead to kidney failure in children. Kidney failure develops as a result of destruction of the small, functional structures and vessels inside the kidney. HUS is a serious illness and potentially fatal. However, more than 85% of people with the most common form of HUS recover complete kidney function.

What causes hemolytic uremic syndrome?

HUS is more common during the summer months and may occur in outbreaks. Outbreaks have been reported in daycare centers, water parks, and fast food restaurants as a result of undercooked hamburger meat.

HUS has several known causes and some unknown causes. Typically in children, HUS develops after an infection with the E. coli bacterium. E. coli may be found in contaminated food, such as dairy products and meat. HUS can also develop as a result of taking certain medications or may result from a cancer present in the body, although these causes are less common. Some rare cases of HUS are familial, which suggests a genetic predisposition.

What are the symptoms of hemolytic uremic syndrome?

These are the most common symptoms of HUS. The first symptoms of HUS often last from 1 to 15 days and may include symptoms in the digestive tract, such as:

  • Abdominal pain

  • Bloody or watery diarrhea

  • Vomiting

  • Fever

Severe problems in the bowel and colon may develop in some children. In these cases, even if the digestive symptoms are no longer present, a child may still have the following symptoms:

  • Irritability

  • Fatigue

  • Small, unexplained bruises visible in the lining of the mouth

  • Pale skin

  • Dehydration

The child may produce little urine because damaged red blood cells and other factors may clog the tiny blood vessels in the kidneys, or cause lesions in the kidneys, making them work harder to remove wastes and extra fluid.

The body's inability to rid itself of excess fluid and waste may, in turn, cause the following symptoms:

  • High blood pressure

  • Swelling of the hands and feet

  • Fluid buildup in the tissues (edema)

The symptoms of hemolytic uremic syndrome may look like other medical conditions or problems. Always see your child's doctor for a diagnosis.

How is hemolytic uremic syndrome diagnosed?

In addition to a complete medical history and physical exam, test for hemolytic may include:

  • Blood tests. Done to check blood cell counts, electrolytes, and kidney function

  • Urine tests. Done to check for blood and protein

  • Stool tests. Done to check for blood and to check for bacteria such as E. Coli that are known to cause HUS

What is the treatment for hemolytic uremic syndrome?

There is no known treatment that can stop the progression of the syndrome once it has started. Initially, treatment may be supportive, which means that there is no cure for the specific disease, so it is necessary to treat the symptoms. If your child shows signs of dehydration and electrolyte irregularities, these conditions will be treated first. Other therapies may include:

  • Intensive care. Close monitoring in an intensive care unit (ICU) may be needed.

  • Blood transfusions. Blood transfusions may be needed to treat moderate to severe cases of anemia (low red blood cell count).

  • Nutrition. Your child may need intravenous (IV) nutrition if he or she is having severe digestive tract complications.

  • Dialysis. Dialysis may be needed in up to half of all children who develop HUS. Dialysis is a medical procedure to remove wastes and additional fluid from the blood after the kidneys have stopped working.

  • Medicine. Medicine may be needed to treat your child's blood pressure, which may be elevated.

How can hemolytic uremic syndrome be prevented?

Completely cooking all foods that may contain hamburger meat can prevent HUS that is caused by E. coli. Other possible sources of E. coli include unpasteurized juices or milk.

If your child has HUS, it is important to notify your daycare center or your child's other close contacts (for example, play groups and school). HUS is not contagious, but spread of the E. coli bacterium is contagious.