Hemolytic-uremic syndrome natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2], Anila Hussain, MD [3]

Overview

Approximately 15 percent of patients with EHEC or Shiga toxin producing E.coli infection will develop HUS presenting with blood diarrhea, nausea, vomiting, and decreased urination. Common complications of HUS include renal failure which can be acute (AKI) or develop over time (chronic renal failure), hypertension, neurological problems such as stroke, seizure, coma and eventually death. Prognosis depend on the associated complications and about 12% of patients with diarrhea-associated HUS progress to end stage renal failure within 4 years and about 25% have long term renal impairment leading to 9% renal transplants in children and adolescents.

Natural History, Complications, and Prognosis

Natural History

• The symptoms of HUS usually develop after eating of contaminated food in the first diarrhea is watery and become to bloody later and start with symptoms such as abdominal pain, nausea and vomiting accompany diarrhea, fever is observed less commonly.
• The symptoms of HUS typically develop 5–15% of the cases.
• If left untreated 15% of patients with HUS may progress to develop rectal prolapse, acute renal failure, colonic gangrene, and mortality.

Complications

Common complications of HUS include:

• Acute kidney injury (AKI) in childern (Most common)
• Hypertension (HTN)
• End-stage renal disease
• Renal transplants in children and adolescents (Approximately 9%)
• Neurological complications (10-50%)
  • hemiparesis
  • seizure
  • coma
  • stroke
• Death

Prognosis

Common complications of HUS include:

• Approximately 15% of patients of EHEC‐associated gastroenteritis will develop HUS although it is dependent on bacterial strain and geographic location.
• About 12% of patients with diarrhea-associated HUS progress to end stage renal failure within 4 years and about 25% have long term renal impairment.
• 9% renal transplants in children and adolescents.
• Encephalopathy occurs in patients infected with enterohemorrhagic Escherichia coli (E. coli) has a high mortality rate and patients sometimes present sequelae.