0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
JAMA Patient Page |

Hemolytic Uremic Syndrome FREE

Ann R. Punnoose, MD, Writer; Cassio Lynm, MA, Illustrator; Robert M. Golub, MD, Editor
JAMA. 2012;307(10):1098. doi:10.1001/jama.2012.225.
Text Size: A A A
Published online

Hemolytic uremic syndrome (HUS) is a disease that usually affects infants and children. The most common form of HUS is caused by consuming food or water contaminated with strains of Escherichia coli bacteria called enterohemorrhagicE coli. The first symptoms of infection include diarrhea, which may be bloody. Toxins released by the bacteria are thought to damage the intestines and then spread through the blood to the kidneys. Hemolytic uremic syndrome may develop within 1 week of the appearance of diarrhea and is considered the most common cause of sudden kidney failure in children. Atypical HUS is a less common form and is associated with improper function of the complement system, blood proteins involved in the natural immune response. This form of HUS is sometimes hereditary and recurrent. The March 14, 2012, issue of JAMA includes an article on enterohemorrhagic E coli .

DIAGNOSIS

Hemolytic uremic syndrome is diagnosed when patients present with

  • thrombocytopenia (low numbers of platelets).

  • microangiopathic hemolytic anemia (anemia caused by damage to red blood cells). Patients may appear pale because of anemia.

  • decreased kidney function, sometimes with decreased urine output (oliguria) or no urine production at all (anuria). Patients may develop hypertension and edema (swelling).

TREATMENT

  • Although patients with HUS may be dehydrated, fluids are given very carefully so that the kidneys, which may not be functioning at normal capacity, are not overwhelmed.

  • Urine output, a marker for kidney function, is monitored very closely.

  • Patients with HUS may require dialysis (blood filtering) to temporarily perform the functions of the kidney.

  • Patients may receive blood transfusions if their blood counts are very low.

  • Antibiotics are generally not used to treat HUS because of concerns that killing the bacteria would release more toxins and worsen symptoms.

  • Patients with atypical HUS may be treated with plasma (fluid portion of blood) to replace complement proteins or antibodies (blood proteins that are part of the immune system) that block complement activation.

PROGNOSIS

The course of HUS varies from patient to patient. Some may require hospitalization for a short time while others may require monitoring and care in the intensive care unit and even dialysis or plasma exchange (removal, treatment, and replacement of the blood plasma). In severe cases, other organ systems can be affected. Most patients with HUS require close follow-up after they are discharged from the hospital to ensure that their kidney function improves or remains normal. Patients with atypical HUS tend to have a recurrent course of disease that may lead to renal failure.

FOR MORE INFORMATION

INFORM YOURSELF

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's website at www.jama.com. Many are available in English and Spanish.

Sources: Centers for Disease Control and Prevention, Mayo Clinic, National Kidney and Urologic Diseases Information Clearinghouse

Topic: NEPHROLOGY

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Tables

References

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Spanish Patient Pages
Supplemental Content

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles