Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS)

Johanna Scheiring, Sharon Andreoli, Lothar Bernd Zimmerhackl

Research output: Contribution to journalArticle

172 Citations (Scopus)

Abstract

Hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure in childhood and the reason for chronic renal replacement therapy. It leads to significant morbidity and mortality during the acute phase. In addition to acute morbidity and mortality, long-term renal and extrarenal complications can occur in a substantial number of children years after the acute episode of HUS. The most common infectious agents causing HUS are enterohemorrhagic Escherichia coli (EHEC)-producing Shiga toxin (and belonging to the serotype O157:H7) and several non-O157:H7 serotypes. D+ HUS is an acute disease characterized by prodromal diarrhea followed by acute renal failure. The classic clinical features of HUS include the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. HUS mortality is reported to be between 3% and 5%, and death due to HUS is nearly always associated with severe extrarenal disease, including severe central nervous system (CNS) involvement. Approximately two thirds of children with HUS require dialysis therapy, and about one third have milder renal involvement without the need for dialysis therapy. General management of acute renal failure includes appropriate fluid and electrolyte management, antihypertensive therapy if necessary, and initiation of renal replacement therapy when appropriate. The prognosis of HUS depends on several contributing factors. In general "classic" HUS, induced by EHEC, has an overall better outcome. Totally different is the prognosis in patients with atypical and particularly recurrent HUS. However, patients with severe disease should be screened for genetic disorders of the complement system or other underlying diseases.

Original languageEnglish
Pages (from-to)1749-1760
Number of pages12
JournalPediatric Nephrology
Volume23
Issue number10
DOIs
StatePublished - 2008

Fingerprint

Shiga Toxin
Hemolytic-Uremic Syndrome
Acute Kidney Injury
Enterohemorrhagic Escherichia coli
Renal Replacement Therapy
Mortality
Dialysis
Morbidity
Kidney
Inborn Genetic Diseases
Hemolytic Anemia
Acute Disease
Thrombocytopenia
Antihypertensive Agents
Electrolytes
Diarrhea
Therapeutics
Central Nervous System

Keywords

  • Complement
  • Complications
  • Diarrhea
  • Enterohemorrhagic Escherichia coli (EHEC)
  • Hemolyticuremic syndrome
  • Shigatoxin (Stx)1 and Stx2

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

Cite this

Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). / Scheiring, Johanna; Andreoli, Sharon; Zimmerhackl, Lothar Bernd.

In: Pediatric Nephrology, Vol. 23, No. 10, 2008, p. 1749-1760.

Research output: Contribution to journalArticle

Scheiring, Johanna ; Andreoli, Sharon ; Zimmerhackl, Lothar Bernd. / Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). In: Pediatric Nephrology. 2008 ; Vol. 23, No. 10. pp. 1749-1760.
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