Hemolytic uremic syndrome: Difference between revisions

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==Background==
==Background==
*Similar to but different from [[TTP]] (which is more common in adults)
*Similar to but different from [[TTP]] (which is more common in adults)
*Most cases occur in children <10yr (2/3 of cases in <5yr)
*Most cases due to E. coli O157:H7 infection
**Shiga toxin may induce autoantibody to CD36 (found on endothelial cells and platelets)
**May also be caused by shigella, yersinia, campylobacter, salmonella
*Types:
**Typical
***Occurs 2-14d after development of infectious diarrhea (bloody, no fever)
**Atypical
***Occurs in older children and adults
***Extrarenal involvement is common (difficult to distinguish from TTP)
***May be caused by atypical pathogens (EBV, S. pneumo) or immunosuppression


*Triad of:
==Clinical Features==
**Acute renal failure, thrombocytopenia, microangiopathic hemolytic anemia
#Triad:
*Most common cause of ARF in children
##Acute renal failure
**Most common in children <10yr (2/3 of cases in <5yr)
###Oliguria
*Most common cause is E. coli O157:H7 infection
##Thrombocytopenia
##Microangiopathic hemolytic anemia
#Enteritis
##N/V, diarrhea (usually bloody), +/- fever
#Hyperglycemia
##Pancreatic beta-cell dealth due to microthrombi within pancreas


==Diagnosis==
===Presentation===
*E. coli enteritis
**N/V, bloody diarrhea
**Within a week develops pallor, oliguria, lethargy, sz, encephalopathy
**Within a week develops pallor, oliguria, lethargy, sz, encephalopathy
==DDx==
*Acute gastroenteritis
*Appendicitis
*Colitis
*Intussusception
*IBD
*Perforation
*DIC
*TTP
*SLE


==Work-Up==
==Work-Up==
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**WBC may be elevated
**WBC may be elevated
**Anemia
**Anemia
***Schistocytes, helmet/burr cells
***Schistocytes
**Thrombocytopenia
**Thrombocytopenia
*Stool tests
*Stool tests
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*UA
*UA
**Hematuria, casts
**Hematuria, casts
*Bilirubin (hemolysis)
*LFT
**Increased bilirubin
*Chemistry
*Chemistry
**Hyperkalemia (renal failure)
**Creatinine, hyperkalemia (renal failure)
 
==DDx==
*Acute gastroenteritis
*Appendicitis
*Colitis
*Intussusception
*IBD
*Perforation
*DIC
*TTP
*SLE


==Treatment==
==Treatment==
*Supportive
*Supportive care
**Fluid for hypovolemia, transfusion for anemia
**Fluid for hypovolemia
*Antibiotics are not indicated
**Transfusion for anemia
*Abx are not indicated
*Antimotility agents are contraindicated
*Platelets are contraindicated
*Platelets are contraindicated
*Emergency dialysis if indicated
*Emergency dialysis for acute renal failure


==Disposition==
==Disposition==
Admit all
*Admit


==Source==
==Source==

Revision as of 01:14, 21 October 2011

Background

  • Similar to but different from TTP (which is more common in adults)
  • Most cases occur in children <10yr (2/3 of cases in <5yr)
  • Most cases due to E. coli O157:H7 infection
    • Shiga toxin may induce autoantibody to CD36 (found on endothelial cells and platelets)
    • May also be caused by shigella, yersinia, campylobacter, salmonella
  • Types:
    • Typical
      • Occurs 2-14d after development of infectious diarrhea (bloody, no fever)
    • Atypical
      • Occurs in older children and adults
      • Extrarenal involvement is common (difficult to distinguish from TTP)
      • May be caused by atypical pathogens (EBV, S. pneumo) or immunosuppression

Clinical Features

  1. Triad:
    1. Acute renal failure
      1. Oliguria
    2. Thrombocytopenia
    3. Microangiopathic hemolytic anemia
  2. Enteritis
    1. N/V, diarrhea (usually bloody), +/- fever
  3. Hyperglycemia
    1. Pancreatic beta-cell dealth due to microthrombi within pancreas
    • Within a week develops pallor, oliguria, lethargy, sz, encephalopathy

DDx

  • Acute gastroenteritis
  • Appendicitis
  • Colitis
  • Intussusception
  • IBD
  • Perforation
  • DIC
  • TTP
  • SLE

Work-Up

  • CBC
    • WBC may be elevated
    • Anemia
      • Schistocytes
    • Thrombocytopenia
  • Stool tests
    • Shiga toxin, E. coli O157:H7 test
  • UA
    • Hematuria, casts
  • LFT
    • Increased bilirubin
  • Chemistry
    • Creatinine, hyperkalemia (renal failure)

Treatment

  • Supportive care
    • Fluid for hypovolemia
    • Transfusion for anemia
  • Abx are not indicated
  • Antimotility agents are contraindicated
  • Platelets are contraindicated
  • Emergency dialysis for acute renal failure

Disposition

  • Admit

Source

Tintinalli

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