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Hemolytic (HEE-mo-LIT-ik) uremic (yoo-REE-mik) syndrome, or HUS, is one of
the most common causes of sudden, short-term kidney failure in children. In
severe cases, this acute kidney failure may require several sessions of dialysis
to take over the kidneys' job of filtering wastes from the blood, but most
children recover without permanent damage to their health.
Most cases of HUS occur after an infection of the digestive system by Escherichia
coli bacterium, which is found in contaminated foods like meat, dairy
products, and juice. Some people have contracted HUS after swimming in pools or
lakes contaminated with feces. Washing and cooking foods adequately, avoiding
undercooked meats, and avoiding unclean swimming areas are the best ways to
protect your children from this disease.
The infection of the digestive tract is called gastroenteritis and may cause
the child to vomit and have stomach cramps and bloody diarrhea. Most children
who experience gastroenteritis recover fully in 2 or 3 days and do not develop
HUS. In a few children, however, HUS develops when the bacteria lodged in the
digestive system make toxins that enter the bloodstream and start to destroy red
blood cells.
Symptoms of HUS may not become apparent until a week after the digestive
problems. The child remains pale, tired, and irritable. Other symptoms include
small, unexplained bruises or bleeding from the nose or mouth that may occur
because the toxins also destroy the platelets, cells that normally help
clotting.
You may notice that your child's urine output decreases. Urine formation
slows because the damaged red blood cells clog the tiny blood vessels in the
kidneys, making them work harder to remove wastes and extra fluid from the
blood. The body's inability to rid itself of excess fluid and wastes may in turn
cause high blood pressure or swelling of the face, hands, feet, or the entire
body. This progression to acute kidney failure occurs in about half the cases of
HUS.
Healthy red blood cells (upper left) are smooth and
round. In hemolytic uremic syndrome (lower right), toxins destroy red
blood cells. These misshapen cells may clog the tiny blood vessels in
the kidneys.
Call your child's doctor immediately if you notice unexplained bruises,
unusual bleeding, swollen limbs or generalized swelling, extreme fatigue, or
decreased urine output in your child. You should call your doctor or visit an
emergency room if your child goes 12 hours without urinating.
Treatments, which consist of maintaining normal salt and water levels in the
body, are aimed at easing the immediate symptoms and preventing further
complications. Blood transfusions (packed red blood cells) are sometimes
necessary, and high blood pressure may need treatment. Only the most severe
cases require dialysis. Some children may sustain significant kidney damage that
slowly develops into permanent kidney failure and will then require long-term
peritoneal dialysis or hemodialysis or a kidney transplant. Most children
recover completely with no long-term consequences.
Some parents feel a sense of responsibility for their child's illness after a
case of HUS. While the disease may ultimately have been preventable, caregivers
should not feel guilty because the insidious course of the disease cannot be
predicted from the initial bacterial infection, which many children experience
without developing HUS. Caregivers who see that their children receive the
appropriate medical care should rest assured that they have done all that any
caring parent could do.
For more information
American Society of Pediatric Nephrology
James Whitcomb Riley Hospital for Children
Wells Research Center
702 Barnhill Drive, 2600A
Indianapolis, IN 46202
Phone: (317) 278-0854
Internet: http://www.aspneph.com/
Lois Joy Galler Foundation
734 Walt Whitman Road Suite 300
Melville, NY 11747
Phone: (516) 673-3017
Internet: http://www.loisjoygaller.org/
National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Phone: 1-800-622-9010 or (212) 889-2210
Email: info@kidney.org
Internet: http://www.kidney.org/
NIH Publication No. 04-4570
Source: The National Institute of Health;
The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK).
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