HUS

1 What is Hemolytic Uremic Syndrome (HUS)?

Hemolytic uremic syndrome is a condition that results from the abnormal premature destruction of red blood cells. As soon as this process starts, then the damaged red blood cell begin to  the filtering system in the kidney. This may eventually lead to life-threatening kidney failure associated with hemolytic uremic syndrome.

This condition is mostly common in children after 2-14 days of diarrhoea, which is often  bloody due to infection with a certain strain of Escherichia coli (E. coli)  Adults are also capable of developing HUS after an E. coli infection, the cause can also be due to particular medications, other types of infection, pregnancy or the  cause cannot be known at all.

Although HUS is a serious problem, getting well timed treatment leads to full recovery for most individuals, especially children.

2 Symptoms

There are a good number of noticeable signs and symptoms of hemolytic uremic syndrome, some of which include: 

Other symptoms are:

  • blood in urine,
  • unexplained bruises or bleeding from both the nose and mouth. 

There is also a decrease in urination, swelling  of the face,hands, feet or the whole body. One can show signs of confusion and in some instances, neurological symptoms such as  seizures may develop.

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3 Causes

There are various known causes of hemolytic uremic syndrome (HUS). However, the most common , particularly in children is an infestation with a specific strain known as O157:H7. However,  other strains of E. coli have been linked to  hemolytic uremic syndrome.

E. coli refer to  a species of bacteria commonly found in the intestines of humans and animals. Most of the hundreds of E. coli known to exist are harmless.  It should be noted that there are some types of E. coli that are quite pernicious, and are responsible for serious foodborne  infections such as, those related to hemolytic uremic syndrome. E. coli may be found in contaminated meat or produce and swimming pools or lakes contaminated with feces.

The majority of individuals who are infected with E. coli, even the more dangerous strains, wont develop hemolytic uremic syndrome. It is also possible for HUS to follow infection with other kinds of bacteria.

In adults, the cause of HUS may be caused by other factors which include:

  • the use of certain medications, such as such as quinine,
  • some chemotherapy drugs,
  • the immunosuppressant medication cyclosporine,
  • anti-platelet medications.

Pregnancy can also lead to this condtion.

Certain infections, such as HIV/AIDS or an infection with the pneumococcal bacteria Genes, which can be a factor because a certain type of HUS — atypical hemolytic uremic syndrome — may be passed down from  parents to their children.

The cause of hemolytic uremic syndrome in adults is often unknown.

4 Making a Diagnosis

If a doctor has a suspicion of hemolytic uremic syndrome, various lab tests may be carried out to confirm the diagnosis.

For the reason that most individuals with HUS are admitted to a hospital after a trip to the emergency room or a brief phone call or visit with their doctor, it is highly unlikely that a child will have a routine visit.

However, if a child is experiencing symptoms of HUS after several days of diarrhea, it is highly advised to make an immediate call to a doctor and be prepared to answer the following questions:

  • Have you noticed blood in your or your child's diarrhea?
  • What other signs and symptoms — such as fever, swelling or decreased urine output — have you or your child experienced?
  • How long have you or your child been experiencing these symptoms?
  • How long has it been since you or your child urinated? 

It is a good idea to try to replace the fluids lost due to an earlier diarrhea with the use of an oral rehydrating solution, such as Ceralyte, Pedialyte or Oralyte. It is unadvisable to administer one any medication to stop diarrhea if there is  any evidence of blood in the stool.

The medications, such as bismuth subsalicylate and loperamide (Immodium), may increase the risk of hemolytic uremic syndrome.

If a doctor has a suspicion of hemolytic uremic syndrome, various lab tests may be carried out to confirm the diagnosis.

Blood tests may reveal a low platelet count, low red blood cell count or a higher than normal level of creatinine  (a breakdown product of creatine), an important part of muscle in the blood. A blood sample can also be used to determine whether red blood cells are damaged or not.

A doctor may also collect a urine sample to test for blood in  urine. 

Additionally, a doctor may take a stool sample to test for the presence of bacteria.

5 Treatment

Hemolytic uremic syndrome (HUS) always requires medical treatment.

With a  view to easing the signs and symptoms or to prevent the aggravation of the condition, the following treatment can be given:

Any lost fluids and electrolytes need to be carefully replaced because the kidneys are not functioning as efficient as possible.

Another way is through red blood cell transfusions.

The symptoms that accompany inadequate number of red blood cells are chilled feeling, fatigue and a shortness of  breath. Heart rate may also increase, skin has a yellow appearance and  urine is dark in colour. Red blood cells given through  an intravenous needle, may help reverse these signs and symptoms. Platelet transfusions can also be carried out.

In the case whereby an individual is bleeding or bruising easily, platelet transfusions can speedup the clotting process. Like red blood cell transfusions, platelet transfusions are also administered intravenously. Another mode of treatment is by a plasma exchange. Plasma is the part of blood that supports the circulation of blood cells and platelets.

In some cases, a machine is used to clear the blood of its own plasma and replace it with fresh or frozen donor plasma.

6 Prevention

The specific preventive measures for hemolytic uremic syndrome are not clear. However, being cautious against E. coli and other foodborne diseases is one way that can help to avoid HUS. It is important to  that meat or any other food product will not have a particular look, feel or scent to indicate the presence of E.coli.

The following can be done to reduce the risks of illborne illness: 

  • washing hands, keep utensils and food surfaces clean.
  • Keeping raw foods away from ready-to-eat foods,
  • defrost raw meat in a microwave (do not leave meat on the counter to thaw). 
  • It is advisable to cook ground beef to at least 160 F  or 71 C throughout.  Checking the temperature with the thermometer is advisable.  When reheating already cooked food, one must always make sure the internal temperature reaches 165 F or 74 C.
  • Washing fruits and vegetables, avoiding unpasteurized milk, juice and cider. Swimming in water contaminated with faeces is very unhealthy and can lead to illness. 

In general, maintaining a very good hygiene and being cautious about the condition of food before eating it may help prevent foodborne diseases.

7 Risks and Complications

The most at risk of developing hemolytic uremic syndrome (HUS) are:

  • children under 5 years,
  • individuals with certain genetic changes that make them more susceptible.

Young children and the elderly are the most likely to be seriously ill from hemolytic uremic syndrome.

HUS can cause a number of serious, life-threatening complications, including:

  • Sudden (acute) kidney failure,
  • High blood pressure,
  • Chronic kidney failure,
  • Heart problems,
  • stroke,
  • coma.
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