Definition of Hemolytic Uremic Syndrome

Hemolytic Uremic Syndrome – renal failure that occurs as a rare complication in children after infection with Escherichia coli O157:H7 acquired from contaminated food. E. coli O157:H7 causes hemorrhagic enteritis, itself a life-threatening infection. Hemolytic uremic syndrome occurs when the toxins the E. coli O157:H7 release enter the bloodstream.

The toxins destroy erythrocytes (red blood cells) and platelets (clotting cells). Remnants of the destroyed blood cells clog the glomeruli within the kidneys, preventing blood from flowing through these filtering structures. As more glomeruli become affected, the kidneys can no longer filter toxins from the blood.

Symptoms and Diagnostic Path

The symptoms of hemolytic uremic syndrome begin to emerge as the child appears to be recovering from the enteritis. The earliest indication of hemolytic uremic syndrome is the appearance of petecchiae, pinpoint hemorrhages under the surface of the skin, in a child recovering from E. coli O157:H7 hemorrhagic enteritis.

Other symptoms include reduced urine volume, fatigue, irritability, and pale skin. Blood tests typically show the damaged blood cells and indications of diminishing kidney function. However, the child becomes lifethreateningly ill very rapidly, requiring immediate hospitalization and intensive medical treatment.

Treatment Options and Outlook

There is no cure for hemolytic uremic syndrome. Treatment consists of intensive supportive care while the condition runs its course, including efforts to maintain the child’s fluid and electrolyte balances as well as renal dialysis to filter toxins from the blood. The renal failure disrupts all body systems and functions, often causing severe hypertension (high blood pressure), other cardiovascular problems, liver dysfunction, and neurologic dysfunction. With prompt and aggressive medical care, 80 percent of children survive. About 70 percent of them recover fully with no residual health problems. Among the other 30 percent renal failure progresses to end-stage renal disease (esrd), often within months though sometimes over several years, requiring long-term renal dialysis and ultimately kidney transplantation.

Risk Factors and Preventive Measures

Hemolytic uremic syndrome is a rare complication of E. coli O157:H7 hemorrhagic enteritis, so any child who acquires this infection incurs the risk for the syndrome. There are no measures to prevent hemolytic uremic syndrome as a complication of E. coli O157:H7 infection.

Even with prompt and aggressive medical care for the hemorrhagic enteritis, hemolytic uremic syndrome remains a potential complication. The most effective preventive measures are precautions to protect against E. coli O157:H7 infection. Such measures include

  • wash hands with hot, soapy water before and after handling meats
  • do not handle other foods when preparing meats
  • use separate, nonporous surfaces and utensils (not wooden) to prepare meats for cooking
  • wash food preparation surfaces and utensils with hot soapy water immediately after preparing meats
  • thoroughly cook all meats to the recommended temperatures for the kind of meat
  • thoroughly rinse all fruits and vegetables in cold running water before eating or preparing them

See also FOOD-BORNE ILLNESSES; GLOMERULUS.

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