With thanks to Dr David Gardiner, one of our current paediatric FY2 doctors at Homerton University Hospital, for updating us on HUS.

Presentation:

• Profuse diarrhoea that typically turns bloody after 1-3 days
• Abdominal pain (crampy)
• Vomiting
• Fever (sometimes)
• Oedema
• Reduced urine output (abrupt onset) but also polyuria/normal urine output (rarer)
• Neurological complications: seizure, coma, cranial nerve palsies, confusion, hallucinations
• Classic triad – anaemia, uraemia and thrombocytopaenia
• Most common in children under the age of 5

Investigations:

• B/P – hypertension
• Blood film: Fragmentation and signs of haemolysis (Coombs test negative)
• Raised WCC and neutrophils, low platelets, low Hb
• Raised LDH
• Clotting screen typically normal (cf DIC)
• Raised bilirubin, low albumin
• Urea and creatinine raised
• Stool for PCR E.Coli
  

Management:

• Refer to secondary care urgently
• Strict input/output fluid monitoring
• Correction of anaemia
• Correction of electrolyte imbalances
• Antihypertensive therapy if required
• Dialysis
• Furosemide to induce diuresis
• Report to PHE – can’t go back to school until 2 negative stool samples

More resources:

Kidney Research website on HUS

https://patient.info/doctor/haemolytic-uraemic-syndrome-pro#ref-8