Hemolytic uremic syndrome An acute renal disease characterized by a triad of manifestations: ARF, hemolytic anemia, and thrombocytopenia Etiology

Hus caused by enteric infection of E.coli O157:H7 serotype is the most prevalent pathogen in the US and Europe. The disease usually follows an acute gastrointestinial or upper respiratory tract infection. Patho The primary site of injury appears to be the endothelial lining of the small glomerular arterioles, but other organs and tissues may be involved (e.g. liver, brain, heart, pancreatic islet cells, and muscles). The endothelium becomes swollen and occluded with the deposition of platelets and fibrin clots (intravascular coagulation). Red blood cells are damaged as they move through the partially occluded blood vessels. The spleen removes these fragmented red blood cells, causing acute hemolytic anemia. Fibrolytic action on the precipitated causes the fibrin split products to appear in the serum and urine. The characteristic thrombocytopenia is produced by the placenta aggregation within damaged blood vessels or the damage and removal of platelets. Clinical Manifestation This disease occurs after a prodromal period during which there is an episode of diarrhea and vomiting. Less often preceding illness is an upper respiratory tract infection or, ocassionally, varicella, measles or UTI. The hemolytic process persists for several days to 2 weeks. During this time the child is anorexia, irritable, and lethargic. There is marked and rapid onset of pallor accompanied by hemorrhagic manifestations such as bruising, purpura, or rectal bleeding. Severely affected pts. are anuric and often hypertensive. Seizures and stupors suggest CNS involvement, and there may be signs of acute heart failure. Mild cases demonstrate anemia, thrombocytopenia, and azotemia; urinary output may be reduced or increased. Diagnostic The triad of anemia, thrombocytopenia, and renal failure is sufficient for diagnosis. Proteinuria, hematuria, urinary casts evidence of renal involvement; BUN and serum creatinine levels are elevated. A low hemoglobin and hematocrit and a high reticulocyte count confirm the hemolytic nature of the anemia Therapeutic Management Providers direct treatment toward control of the complications and hematologic manifestations of renal failure.Those used in managing renal failure: Fluid replacement, tx of HTN, and correction of acidosis and electrolyte disorders. The most consistently effective tx is early hemodialysis for any pt who has been anuric for 24 hours or who demonstrate oliguria with uremia or HTN and seizures.
Diet: Low-salt diet to decrease risk of hypertension, Diet high in iron and folic acid content to help recover from anemia, High-energy diet to help patient regain lost weight