Hemolytic uremic syndrome - Revision history

Danbot: Add MedicationDose SMW entries for nifedipine, nitroprusside; doses verified against pediatric hematology guidelines

2026-03-20T17:58:30Z

Add MedicationDose SMW entries for nifedipine, nitroprusside; doses verified against pediatric hematology guidelines

← Older revision		Revision as of 17:58, 20 March 2026
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	==Disposition==		==Disposition==
	*Admit		*Admit


			==Medication Dosing==
			===Hypertension===
			*{{MedicationDose\|drug=Nifedipine\|dose=0.25-0.5 mg/kg/day\|route=PO\|context=Antihypertensive\|indication=Hemolytic uremic syndrome\|population=Pediatric}}
			*{{MedicationDose\|drug=Nitroprusside\|dose=0.3-0.5 mcg/kg/min\|route=IV drip\|context=Antihypertensive (severe)\|indication=Hemolytic uremic syndrome\|population=Pediatric\|max_dose=10 mcg/kg/min}}

	==See Also==		==See Also==

Athorne: /* Management */

2023-05-20T13:58:01Z

Management

← Older revision		Revision as of 13:58, 20 May 2023
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	**Usually performed if anuria or neurologic sequela		**Usually performed if anuria or neurologic sequela
	*[[Eculizumab]]		*[[Eculizumab]]
	**Monoclonal anti-C5 antibody that interrupts complement cascade		**Monoclonal anti-C5 antibody that interrupts complement cascade. Shown to be effective in cases of atypical HUS (those not due to shiga toxin forming bacteria).
	*Transfusion of RBCs(only severe bleeding)		*Transfusion of RBCs(only severe bleeding)
	**Generally only indicated if plasma exchange cannot be performed immediately		**Generally only indicated if plasma exchange cannot be performed immediately

Athorne: /* Evaluation */

2023-05-20T13:56:09Z

Evaluation

← Older revision		Revision as of 13:56, 20 May 2023
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	**Increased bilirubin		**Increased bilirubin
	*Chemistry		*Chemistry
	**Creatinine elevation, [[uremia]], [[hyperkalemia]] ([[renal failure]])		**Creatinine elevation (often more pronounced than TTP), [[uremia]], [[hyperkalemia]] ([[renal failure]])

	===Diagnosis===		===Diagnosis===

Athorne: /* Clinical Features */

2023-05-20T13:55:14Z

Clinical Features

← Older revision		Revision as of 13:55, 20 May 2023
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	==Clinical Features==		==Clinical Features==
			*Consider in any child with diarrheal illness (especially bloody) with renal dysfunction

	===Triad===		===Triad===
	#[[Renal Failure\|Acute renal failure]]		#[[Renal Failure\|Acute renal failure]]

Rossdonaldson1: /* Background */

2022-01-08T04:57:07Z

Background

← Older revision		Revision as of 04:57, 8 January 2022
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	==Background==		==Background==
	File:Schizocyte smear 2009-12-22.jpg\|thumb\|Schistocytes as seen in a person with hemolytic–uremic syndrome.]]		[[File:Schizocyte smear 2009-12-22.jpg\|thumb\|Schistocytes as seen in a person with hemolytic–uremic syndrome.]]
	*Abbreviation: HUS		*Abbreviation: HUS
	*Similar to [[TTP]] (which is more common in adults), but associated with less central nervous system and more renal involvement.		*Similar to [[TTP]] (which is more common in adults), but associated with less central nervous system and more renal involvement.

Rossdonaldson1: /* Background */

2022-01-08T04:56:50Z

Background

← Older revision		Revision as of 04:56, 8 January 2022
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	==Background==		==Background==
			File:Schizocyte smear 2009-12-22.jpg\|thumb\|Schistocytes as seen in a person with hemolytic–uremic syndrome.]]
	*Abbreviation: HUS		*Abbreviation: HUS
	*Similar to [[TTP]] (which is more common in adults), but associated with less central nervous system and more renal involvement.		*Similar to [[TTP]] (which is more common in adults), but associated with less central nervous system and more renal involvement.
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	*Shiga toxin may induce autoantibody to CD36 (found on endothelial cells and platelets)		*Shiga toxin may induce autoantibody to CD36 (found on endothelial cells and platelets)
	*May also be caused by [[shigella]], [[yersinia]], [[campylobacter]], [[salmonella]]		*May also be caused by [[shigella]], [[yersinia]], [[campylobacter]], [[salmonella]]

	===Types===		===Types===
	#Typical		#Typical

Rossdonaldson1: /* Evaluation */

2022-01-08T04:53:15Z

Evaluation

← Older revision		Revision as of 04:53, 8 January 2022
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	==Evaluation==		==Evaluation==
			===Workup===
	*CBC		*CBC
	**[[Anemia]]		**[[Anemia]]
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	*Chemistry		*Chemistry
	**Creatinine elevation, [[uremia]], [[hyperkalemia]] ([[renal failure]])		**Creatinine elevation, [[uremia]], [[hyperkalemia]] ([[renal failure]])

			===Diagnosis===

	==Management==		==Management==

Elcatracho: /* Management */

2021-02-01T21:12:51Z

Management

← Older revision		Revision as of 21:12, 1 February 2021
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	==Management==		==Management==
	*[[IVF\|~~Fluid~~ resuscitation]]		*Initial management largely supportive with early [[IVF\|fluid resuscitation]]
	*[[Insulin]] therapy if hyperglycemic and ketones (pancreatic insufficiency complication)		*[[Insulin]] therapy if hyperglycemic and ketones (pancreatic insufficiency complication)
	*[[Antihypertensives]]		*[[Antihypertensives]]
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	**Platelet infusion may lead to acutely worsened thrombosis, renal failure, and death		**Platelet infusion may lead to acutely worsened thrombosis, renal failure, and death
	*[[Hemodialysis/Hemoperfusion]]		*[[Hemodialysis/Hemoperfusion]]
	**~~Often needed~~ for ~~renal failure and hyperkalemia treatment~~		**Usually reserved for symptomatic [[uremia]], azotemia (BUN >80 mg/dL), fluid overload or electrolyte abnormalities refractory to medical therapy<ref> Niaudet P, Boyer OG. Overview of hemolytic uremic syndrome in children. Post TW, ed. UpToDate. UpToDate Inc. Accessed February 1st, 2021.</ref>
	*AVOID Antibiotics		*AVOID Antibiotics
	**May lead to worsening lysis of bacteria and further shiga toxin release		**May lead to worsening lysis of bacteria and further shiga toxin release

Elcatracho: /* Evaluation */

2021-01-30T20:43:46Z

Evaluation

← Older revision		Revision as of 20:43, 30 January 2021
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	**Increased bilirubin		**Increased bilirubin
	*Chemistry		*Chemistry
	**Creatinine elevation, [[hyperkalemia]] ([[renal failure]])		**Creatinine elevation, [[uremia]], [[hyperkalemia]] ([[renal failure]])

	==Management==		==Management==

ClaireLewis at 00:44, 15 September 2019

2019-09-15T00:44:20Z

← Older revision		Revision as of 00:44, 15 September 2019
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	===Types===		===Types===
	#Typical		#Typical
	#*Occurs 2-14d after development of infectious diarrhea (bloody, no fever)		#*Occurs 2-14d after development of infectious [[diarrhea]] (bloody, no fever)
	#Atypical		#Atypical
	#*Occurs in older children and adults		#*Occurs in older children and adults
	#*Extrarenal involvement is common (difficult to distinguish from [[TTP]])		#*Extrarenal involvement is common (difficult to distinguish from [[TTP]])
	#*May be caused by atypical pathogens (EBV, S. pneumo) or immunosuppression		#*May be caused by atypical pathogens ([[EBV]], [[S. pneumo]]) or immunosuppression

	==Clinical Features==		==Clinical Features==
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	*Enteritis		*Enteritis
	*[[Nausea/vomiting]], [[diarrhea]] (usually bloody), +/- [[fever]]		*[[Nausea/vomiting]], [[diarrhea]] (usually bloody), +/- [[fever]]
	*Hyperglycemia		*[[Hyperglycemia]]
	*Pancreatic beta-cell death due to microthrombi within pancreas		**Pancreatic beta-cell death due to microthrombi within pancreas

	==Differential Diagnosis==		==Differential Diagnosis==
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	*[[Colitis]]		*[[Colitis]]
	*[[Intussusception]]		*[[Intussusception]]
	*IBD		*[[IBD]]
	*Perforation		*Perforation
	*[[SLE]]		*[[SLE]]
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	==Evaluation==		==Evaluation==
	*CBC		*CBC
	**Anemia		**[[Anemia]]
	**Thrombocytopenia		**[[Thrombocytopenia]]
	**Peripheral smear checking for schistocytes, burr cells, helmet cells, spherocytes and segmented red blood cells		**Peripheral smear checking for schistocytes, burr cells, helmet cells, spherocytes and segmented red blood cells
	*LDH (elevated)		*LDH (elevated)
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	**Shiga toxin, E. coli O157:H7 test		**Shiga toxin, E. coli O157:H7 test
	*[[Urinalysis]]		*[[Urinalysis]]
	**Hematuria, casts		**[[Hematuria (peds)\|Hematuria]], casts
	*~~LFT~~		*[[LFTs]]
	**Increased bilirubin		**Increased bilirubin
	*Chemistry		*Chemistry
	**Creatinine, hyperkalemia (renal failure)		**Creatinine elevation, [[hyperkalemia]] ([[renal failure]])

	==Management==		==Management==
	*Fluid resuscitation		*[[IVF\|Fluid resuscitation]]
	*Insulin therapy if hyperglycemic and ketones (pancreatic insufficiency complication)		*[[Insulin]] therapy if hyperglycemic and ketones (pancreatic insufficiency complication)
	*~~Anti-hypertensives~~		*[[Antihypertensives]]
	**[[Nifedipine]]ER (0.25-0.5 mg/kg/day oral)		**[[Nifedipine]]ER (0.25-0.5 mg/kg/day oral)
	**~~Labetolol~~ 1-3 mg/kg/day, divided into twice daily dosing (12 mg/kg/day up to 1200 mg/day)		**[[Labetalol]] 1-3 mg/kg/day, divided into twice daily dosing (12 mg/kg/day up to 1200 mg/day)
	**Nitroprusside 0.3-0.5 ug/kg/min IV (max 10 ug/kg/min)		**[[Nitroprusside]] 0.3-0.5 ug/kg/min IV (max 10 ug/kg/min)
	*[[Plasma exchange]] (plasmapheresis)		*[[Plasma exchange]] (plasmapheresis)
	**Usually performed if anuria or neurologic sequela		**Usually performed if anuria or neurologic sequela
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	*Transfusion of RBCs(only severe bleeding)		*Transfusion of RBCs(only severe bleeding)
	**Generally only indicated if plasma exchange cannot be performed immediately		**Generally only indicated if plasma exchange cannot be performed immediately
	*Platelet ~~Transfusion~~ is AVOIDED		*[[Platelet transfusion]] is AVOIDED
	**Only used for life-threatening bleeding or intracranial hemorrhage under guidance from hematologist		**Only used for life-threatening bleeding or intracranial hemorrhage under guidance from hematologist
	**Platelet infusion may lead to acutely worsened thrombosis, renal failure, and death		**Platelet infusion may lead to acutely worsened thrombosis, renal failure, and death
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	*AVOID Antimotility agents		*AVOID Antimotility agents
	**Leads to prolonged gut exposure to toxins		**Leads to prolonged gut exposure to toxins
	**Risk of toxic megacolon		**Risk of [[toxic megacolon]]

	==Disposition==		==Disposition==