Hemolytic-uremic syndrome medical therapy: Difference between revisions

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__NOTOC__
__NOTOC__
{{HUS}}
{{HUS}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{S.G.}}
 
Specific treatment includes control of hypertension and seizures


==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
The mainstay of therapy for [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]] [[Hemolytic-uremic syndrome|(HUS)]] is supportive therapy. [[Antibiotic therapy]] is not recommended among patients with [[Hemolytic-uremic syndrome|HUS]]. Hydration and [[intravenous]] ([[IV]]) [[isotonic]] [[Saline (medicine)|saline]] replacment decrease the risk of [[hemolytic-uremic syndrome]] [[HUS|(HUS)]]. Patients with [[Hemolytic-uremic syndrome|HUS]] who have significant clinical bleeding or who require an invasive [[procedure]] should receive [[platelet]] [[transfusions]].
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
*The mainstay of therapy for [[Hemolytic-uremic syndrome|HUS]] is supportive therapy and is self-limited<ref>{{Cite journal
*The mainstay of therapy for [[Hemolytic-uremic syndrome|HUS]] is supportive [[therapy]] and almost all cases of [[HUS]] are self-limited.<ref>{{Cite journal
  | author = [[Silviu Grisaru]]
  | author = [[Silviu Grisaru]]
  | title = Management of hemolytic-uremic syndrome in children
  | title = Management of hemolytic-uremic syndrome in children
Line 59: Line 17:
  | doi = 10.2147/IJNRD.S41837
  | doi = 10.2147/IJNRD.S41837
  | pmid = 24966691
  | pmid = 24966691
}}</ref> .[[Antibiotic therapy]] is not  recommended among patients with [[Hemolytic-uremic syndrome|HUS]] hawevre  there are some antibiotics that decrease risk of [[Hemolytic-uremic syndrome|HUS]] sach as [[quinolones]]. Heparin, [[Antiplatelet drug|anti-platelet]] agents,  [[immunoadsorption,]] [[thrombomodulin]] ([[rhTM]]).[[Fosfomycin]]  should be started within 48-72 hours of the patient's presentation of HUS . Empiric antibiotic therapy  such as  and [[cephalosporins]] for invasive pneumococcal disease should be used fallowing culture results. Recombinant human soluble thrombomodulin (rTM) is a novel medicine taht use to traet children with HUS<ref name=":0" />.<ref>{{Cite journal
}}</ref> However any patient suspected of [[Hemolytic-uremic syndrome|HUS]] should be referred to a kidney center or [[nephrology]] unit or be managed in an [[Intensive care medicine|intensive care unit]].
| author = [[Paul N. Goldwater]] & [[Karl A. Bettelheim]]
*[[Antibiotic therapy]] is not  recommended among patients with E. coli O157:H7 infection. This increases the risk of [[Hemolytic-uremic syndrome|HUS]]. However there are some antibiotics that decrease the risk of [[Hemolytic-uremic syndrome|HUS]] such as [[quinolones]].<ref>{{Cite journal
| title = Treatment of enterohemorrhagic Escherichia coli (EHEC) infection and hemolytic uremic syndrome (HUS)
| journal = [[BMC medicine]]
| volume = 10
| pages = 12
| year = 2012
| month = February
| doi = 10.1186/1741-7015-10-12
| pmid = 22300510
}}</ref><ref>{{Cite journal
| author = [[G. Z. Panos]], [[G. I. Betsi]] & [[M. E. Falagas]]
| title = Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection?
| journal = [[Alimentary pharmacology & therapeutics]]
| volume = 24
| issue = 5
| pages = 731–742
| year = 2006
| month = September
| doi = 10.1111/j.1365-2036.2006.03036.x
| pmid = 16918877
}}</ref><ref>{{Cite journal
  | author = [[C. S. Wong]], [[S. Jelacic]], [[R. L. Habeeb]], [[S. L. Watkins]] & [[P. I. Tarr]]
  | author = [[C. S. Wong]], [[S. Jelacic]], [[R. L. Habeeb]], [[S. L. Watkins]] & [[P. I. Tarr]]
  | title = The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections
  | title = The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections
Line 91: Line 29:
  | doi = 10.1056/NEJM200006293422601
  | doi = 10.1056/NEJM200006293422601
  | pmid = 10874060
  | pmid = 10874060
}}</ref><ref>{{cite journal|doi=10.1097/INF.0b013e31823096a8.}}</ref><ref>{{Cite journal
| author = [[K. Ikeda]], [[O. Ida]], [[K. Kimoto]], [[T. Takatorige]], [[N. Nakanishi]] & [[K. Tatara]]
| title = Effect of early fosfomycin treatment on prevention of hemolytic uremic syndrome accompanying Escherichia coli O157:H7 infection
| journal = [[Clinical nephrology]]
| volume = 52
| issue = 6
| pages = 357–362
| year = 1999
| month = December
| pmid = 10604643
}}</ref><ref>{{Cite journal
}}</ref><ref>{{Cite journal
  | author = [[Nasia Safdar]], [[Adnan Said]], [[Ronald E. Gangnon]] & [[Dennis G. Maki]]
  | author = [[Nasia Safdar]], [[Adnan Said]], [[Ronald E. Gangnon]] & [[Dennis G. Maki]]
Line 112: Line 40:
  | pmid = 12190370
  | pmid = 12190370
}}</ref><ref>{{Cite journal
}}</ref><ref>{{Cite journal
  | author = [[Mini Michael]], [[Elizabeth J. Elliott]], [[Greta F. Ridley]], [[Elisabeth M. Hodson]] & [[Jonathan C. Craig]]
  | author = [[G. Z. Panos]], [[G. I. Betsi]] & [[M. E. Falagas]]
| title = Interventions for haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura
  | title = Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection?
| journal = [[The Cochrane database of systematic reviews]]
  | journal = [[Alimentary pharmacology & therapeutics]]
| issue = 1
  | volume = 24
| pages = CD003595
  | issue = 5
| year = 2009
  | pages = 731–742
| month = January
  | year = 2006
| doi = 10.1002/14651858.CD003595.pub2
| pmid = 19160220
}}</ref><ref>{{Cite journal
| author = [[Andreas Greinacher]], [[Sigrun Friesecke]], [[Peter Abel]], [[Alexander Dressel]], [[Sylvia Stracke]], [[Michael Fiene]], [[Friedlinde Ernst]], [[Kathleen Selleng]], [[Karin Weissenborn]], [[Bernhard M. W. Schmidt]], [[Mario Schiffer]], [[Stephan B. Felix]], [[Markus M. Lerch]], [[Jan T. Kielstein]] & [[Julia Mayerle]]
  | title = Treatment of severe neurological deficits with IgG depletion through immunoadsorption in patients with Escherichia coli O104:H4-associated haemolytic uraemic syndrome: a prospective trial
  | journal = [[Lancet (London, England)]]
  | volume = 378
  | issue = 9797
  | pages = 1166–1173
  | year = 2011
  | month = September
  | month = September
  | doi = 10.1016/S0140-6736(11)61253-1
  | doi = 10.1111/j.1365-2036.2006.03036.x
  | pmid = 21890192
  | pmid = 16918877
}}</ref><ref>{{Cite journal
}}</ref><ref>{{Cite journal
| author = [[Paul N. Goldwater]] & [[Karl A. Bettelheim]]
| title = Treatment of enterohemorrhagic Escherichia coli (EHEC) infection and hemolytic uremic syndrome (HUS)
| journal = [[BMC medicine]]
| volume = 10
| pages = 12
| year = 2012
| month = February
| doi = 10.1186/1741-7015-10-12
| pmid = 22300510
}}</ref>
*Heparin, [[Antiplatelet drug|anti-platelet]] agents, [[immunoadsorption,]] [[thrombomodulin]] ([[rhTM]]).<ref>{{cite journal|doi=10.1097/INF.0b013e31823096a8.}}</ref>
*[[Fosfomycin]] should be started within 48-72 hours of the patient's presentation of HUS.<ref>{{Cite journal
| author = [[K. Ikeda]], [[O. Ida]], [[K. Kimoto]], [[T. Takatorige]], [[N. Nakanishi]] & [[K. Tatara]]
| title = Effect of early fosfomycin treatment on prevention of hemolytic uremic syndrome accompanying Escherichia coli O157:H7 infection
| journal = [[Clinical nephrology]]
| volume = 52
| issue = 6
| pages = 357–362
| year = 1999
| month = December
| pmid = 10604643
}}</ref>
*[[Empiric therapy|Empiric]] [[antibiotic]] [[therapy]] such as [[cephalosporins]] for invasive [[Pneumococcal infections|pneumococcal]] disease should be used following culture results.
*[[Recombinant]] [[human]] [[soluble]] [[thrombomodulin]] (rTM)<ref>{{Cite journal
  | author = [[Yukihiko Kawasaki]], [[Kazuhide Suyama]], [[Atsushi Ono]], [[Tomoko Oikawa]], [[Shinichiro Ohara]], [[Yuichi Suzuki]], [[Nobuko Sakai]] & [[Mitsuaki Hosoya]]
  | author = [[Yukihiko Kawasaki]], [[Kazuhide Suyama]], [[Atsushi Ono]], [[Tomoko Oikawa]], [[Shinichiro Ohara]], [[Yuichi Suzuki]], [[Nobuko Sakai]] & [[Mitsuaki Hosoya]]
  | title = Efficacy of recombinant human soluble thrombomodulin for childhood hemolytic uremic syndrome
  | title = Efficacy of recombinant human soluble thrombomodulin for childhood hemolytic uremic syndrome
Line 143: Line 85:
  | doi = 10.1111/ped.12165
  | doi = 10.1111/ped.12165
  | pmid = 24134770
  | pmid = 24134770
}}</ref><ref name=":0">{{Cite journal
}}</ref> is a novel [[medicine]] that use to treat children with [[Hemolytic-uremic syndrome|HUS]].<ref name=":0">{{Cite journal
  | author = [[Takashi Honda]], [[Shohei Ogata]], [[Eri Mineo]], [[Yukako Nagamori]], [[Shinya Nakamura]], [[Yuki Bando]] & [[Masahiro Ishii]]
  | author = [[Takashi Honda]], [[Shohei Ogata]], [[Eri Mineo]], [[Yukako Nagamori]], [[Shinya Nakamura]], [[Yuki Bando]] & [[Masahiro Ishii]]
  | title = A novel strategy for hemolytic uremic syndrome: successful treatment with thrombomodulin alpha
  | title = A novel strategy for hemolytic uremic syndrome: successful treatment with thrombomodulin alpha
Line 175: Line 117:
  | doi = 10.1681/ASN.2004100861
  | doi = 10.1681/ASN.2004100861
  | pmid = 15728781
  | pmid = 15728781
}}</ref>
*[[Eculizumab]] is used to treat atypical [[Hemolytic-uremic syndrome|HUS]].<ref>{{Cite journal
| author = [[Rawaa Ebrahem]], [[Salam Kadhem]] & [[Quoc Truong]]
| title = Treatment of Atypical Hemolytic-Uremic Syndrome in the Era of Eculizumab
| journal = [[Cureus]]
| volume = 9
| issue = 3
| pages = e1111
| year = 2017
| month = March
| doi = 10.7759/cureus.1111
| pmid = 28439485
}}</ref>
}}</ref>
===[[Hemolytic-uremic syndrome|HUS]]===
===[[Hemolytic-uremic syndrome|HUS]]===


*  '''[[Acute kidney injury]]'''
*  '''Acute kidney injury'''
*  First stop medicines that are renal toxicity'''<ref>{{Cite journal
**  First discontinue medicines that have [[renal]] [[toxicity]].<ref>{{Cite journal
  | author = [[Mini Michael]], [[Elizabeth J. Elliott]], [[Jonathan C. Craig]], [[Greta Ridley]] & [[Elisabeth M. Hodson]]
  | author = [[Mini Michael]], [[Elizabeth J. Elliott]], [[Jonathan C. Craig]], [[Greta Ridley]] & [[Elisabeth M. Hodson]]
  | title = Interventions for hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: a systematic review of randomized controlled trials
  | title = Interventions for hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: a systematic review of randomized controlled trials
Line 190: Line 144:
  | doi = 10.1053/j.ajkd.2008.07.038
  | doi = 10.1053/j.ajkd.2008.07.038
  | pmid = 18950913
  | pmid = 18950913
}}</ref>'''.[[fluid]] replacement is the mainstay of treatmen'''<ref>{{Cite journal
}}</ref>
**  Fluid replacement is the mainstay of treatment.<ref>{{Cite journal
  | author = [[Mini Michael]], [[Elizabeth J. Elliott]], [[Greta F. Ridley]], [[Elisabeth M. Hodson]] & [[Jonathan C. Craig]]
  | author = [[Mini Michael]], [[Elizabeth J. Elliott]], [[Greta F. Ridley]], [[Elisabeth M. Hodson]] & [[Jonathan C. Craig]]
  | title = Interventions for haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura
  | title = Interventions for haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura
Line 200: Line 155:
  | doi = 10.1002/14651858.CD003595.pub2
  | doi = 10.1002/14651858.CD003595.pub2
  | pmid = 19160220
  | pmid = 19160220
}}</ref>'''.  Majority of patients have  normokalemia<ref name="M. GlatsteinSnehal2012">{{cite journal|last1=M. Glatstein|first1=Miguel|last2=Snehal|first2=Vala|last3=Amir Ahmad|first3=Syed|last4=Scolnik|first4=Dennis|title=Are potassium levels in children with hemolytic uremic syndrome predictive of outcome?|journal=Open Journal of Pediatrics|volume=02|issue=04|year=2012|pages=264–267|issn=2160-8741|doi=10.4236/ojped.2012.24043}}</ref>.Hydration and [[intravenous]] ([[IV]]) [[isotonic]] [[Saline (medicine)|saline]]  replacment decrease risk of  [[hemolytic-uremic syndrome]] ([[HUS]])<ref>{{Cite journal
}}</ref>
  | author = [[Julie A. Ake]], [[Srdjan Jelacic]], [[Marcia A. Ciol]], [[Sandra L. Watkins]], [[Karen F. Murray]], [[Dennis L. Christie]], [[Eileen J. Klein]] & [[Phillip I. Tarr]]
** Maintain adequate [[hydration]] and<nowiki/>  [[electrolyte]]<nowiki/>s during infection by ample fluid ther<nowiki/>apy effects on short and long-term disease outcomes.<ref>{{Cite journal
| title = Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion
| journal = [[Pediatrics]]
| volume = 115
| issue = 6
| pages = e673–e680
| year = 2005
| month = June
| doi = 10.1542/peds.2004-2236
| pmid = 15930195
}}</ref> and  prevent of further complications . Monitor [[hydration]] and [[electrolyte]]<nowiki/>s during infection by ample fluid therapy effects on short- and long-term disease outcomes<ref>{{Cite journal
  | author = [[Gianluigi Ardissino]], [[Francesca Tel]], [[Ilaria Possenti]], [[Sara Testa]], [[Dario Consonni]], [[Fabio Paglialonga]], [[Stefania Salardi]], [[Nicolo Borsa-Ghiringhelli]], [[Patrizia Salice]], [[Silvana Tedeschi]], [[Pierangela Castorina]], [[Rosaria Maria Colombo]], [[Milena Arghittu]], [[Laura Daprai]], [[Alice Monzani]], [[Rosangela Tozzoli]], [[Maurizio Brigotti]] & [[Erminio Torresani]]
  | author = [[Gianluigi Ardissino]], [[Francesca Tel]], [[Ilaria Possenti]], [[Sara Testa]], [[Dario Consonni]], [[Fabio Paglialonga]], [[Stefania Salardi]], [[Nicolo Borsa-Ghiringhelli]], [[Patrizia Salice]], [[Silvana Tedeschi]], [[Pierangela Castorina]], [[Rosaria Maria Colombo]], [[Milena Arghittu]], [[Laura Daprai]], [[Alice Monzani]], [[Rosangela Tozzoli]], [[Maurizio Brigotti]] & [[Erminio Torresani]]
  | title = Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome
  | title = Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome
Line 221: Line 166:
  | doi = 10.1542/peds.2015-2153
  | doi = 10.1542/peds.2015-2153
  | pmid = 26644486
  | pmid = 26644486
}}</ref>. Indications for dialysis in children with HUS are similar to those in children with other forms of [[acute kidney injury]]([[Acute kidney injury|AKI]]) <ref>{{Cite journal
}}</ref>
**  Indications for [[dialysis]] in children with<nowiki/> [[Hemolytic-uremic syndrome|HUS]] are similar to those in children with other forms of [[acute kidney injury]] ([[Acute kidney injury|AKI]]).<ref>{{Cite journal
  | author = [[Jennifer G. Jetton]], [[Louis J. Boohaker]], [[Sidharth K. Sethi]], [[Sanjay Wazir]], [[Smriti Rohatgi]], [[Danielle E. Soranno]], [[Aftab S. Chishti]], [[Robert Woroniecki]], [[Cherry Mammen]], [[Jonathan R. Swanson]], [[Shanty Sridhar]], [[Craig S. Wong]], [[Juan C. Kupferman]], [[Russell L. Griffin]] & [[David J. Askenazi]]
  | author = [[Jennifer G. Jetton]], [[Louis J. Boohaker]], [[Sidharth K. Sethi]], [[Sanjay Wazir]], [[Smriti Rohatgi]], [[Danielle E. Soranno]], [[Aftab S. Chishti]], [[Robert Woroniecki]], [[Cherry Mammen]], [[Jonathan R. Swanson]], [[Shanty Sridhar]], [[Craig S. Wong]], [[Juan C. Kupferman]], [[Russell L. Griffin]] & [[David J. Askenazi]]
  | title = Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study
  | title = Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study
Line 232: Line 178:
  | doi = 10.1016/S2352-4642(17)30069-X
  | doi = 10.1016/S2352-4642(17)30069-X
  | pmid = 29732396
  | pmid = 29732396
}}</ref>.
}}</ref>
 
* '''Anemia'''
** '''''Anemia'''''  
** Transfuse packed [[Red blood cell|red blood cells]]<nowiki/>[[Red blood cell|ls]] ([[RBC]]):<ref>{{Cite journal
**:<nowiki/><nowiki/>when hemoglobin (Hgb) or hematocrit  respectively became less than 6 ,18  recommend to  transfuse packed red blood cells (RBC)<ref>{{Cite journal
  | author = [[J. R. Brandt]], [[L. S. Fouser]], [[S. L. Watkins]], [[I. Zelikovic]], [[P. I. Tarr]], [[V. Nazar-Stewart]] & [[E. D. Avner]]
  | author = [[J. R. Brandt]], [[L. S. Fouser]], [[S. L. Watkins]], [[I. Zelikovic]], [[P. I. Tarr]], [[V. Nazar-Stewart]] & [[E. D. Avner]]
  | title = Escherichia coli O 157:H7-associated hemolytic-uremic syndrome after ingestion of contaminated hamburgers
  | title = Escherichia coli O 157:H7-associated hemolytic-uremic syndrome after ingestion of contaminated hamburgers
Line 245: Line 190:
  | month = October
  | month = October
  | pmid = 7931869
  | pmid = 7931869
}}</ref> slowly and patients shoul be obsereved closely and monitor their outputs and plasma potassium to prevent haypekalemia. The goal of  Hgb level after transfiution is between 8-9. g/dL not to be normal level also if Hgb would be as normal level heart failure, pulmonary edema, and hypertension may be happen because of  volume<ref>{{Cite journal
}}</ref>
***  Hemoglobin <6 g/dL
***  Hematocrit < 18
**  Transfusion should be done slowly and patients should be obsereved close<nowiki/>ly.
**  Monitor the plasma [[potassium]] to prevent [[hyperkalemia]].
**  Maintain a goal Hgb level after transfiution of between 8-9 g/dL<nowiki/>.
**  Do no<nowiki/>t try to normalize the hemoglobin as it may lead to heart failur<nowiki/>e, [[pulmonary edema]] and<nowiki/> [[hypertension]] due to <nowiki/>volume overload.<ref>{{Cite journal
  | author = [[B. S. Kaplan]], [[P. D. Thomson]] & [[J. P. de Chadarevian]]
  | author = [[B. S. Kaplan]], [[P. D. Thomson]] & [[J. P. de Chadarevian]]
  | title = The hemolytic uremic syndrome
  | title = The hemolytic uremic syndrome
Line 255: Line 206:
  | month = November
  | month = November
  | pmid = 792781
  | pmid = 792781
}}</ref>.The pateints who undergoing hemodialysis transfusions should be given during dialysis to minimize the risks of hypervolemia and hyperkalemia<ref>{{Cite journal
}}</ref>
**  Patients who undergo hemodialysis, [[transfusions]] sh<nowiki/>ould be given during [[dialysis]] to minimize the risks of [[hypervolemia]]<nowiki/> and [[hyperkalemia]].<ref>{{Cite journal
  | author = [[Hoon Young Choi]] & [[Sung Kyu Ha]]
  | author = [[Hoon Young Choi]] & [[Sung Kyu Ha]]
  | title = Potassium balances in maintenance hemodialysis
  | title = Potassium balances in maintenance hemodialysis
Line 266: Line 218:
  | doi = 10.5049/EBP.2013.11.1.9
  | doi = 10.5049/EBP.2013.11.1.9
  | pmid = 23946760
  | pmid = 23946760
}}</ref>.
}}</ref>  
    .  
*  '''Thrombocytopenia'''
*** '''Thrombocytopenia'''
** Patients w<nowiki/>ith [[Hemolytic-uremic syndrome|HUS]] who are noted to have significant clinical [[bleeding]] or who require an [[Invasive (medical)|invasive]] [[procedure]] should receive [[platelet]] [[transfusions]]<ref>{{Cite journal
| author = [[Phillip I. Tarr]], [[Carrie A. Gordon]] & [[Wayne L. Chandler]]
| title = Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome
| journal = [[Lancet (London, England)]]
| volume = 365
| issue = 9464
| pages = 1073–1086
| year = 2005
| month = March
| doi = 10.1016/S0140-6736(05)71144-2
| pmid = 15781103
}}</ref>
 
* '''Hypertension'''
** At the first [[Indication (medicine)|indication]] of [[hypertension]] [[Fluid|fluids]] should be restricted. [[Dialysis]] is more effective than [[Diuretic|diuretics]].
** [[Calcium channel blocker|Calcium channel blockers]] should be used as the initial choice of [[antihypertensive agents]] and after this phase [[antihypertensive therapy]] should be changed to [[ACE inhibitor|ACE inhibitors]] in patients who appear to have long-term renal [[sequelae]].<ref>{{Cite journal
  | author = [[Phillip I. Tarr]], [[Carrie A. Gordon]] & [[Wayne L. Chandler]]
  | title = Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome
  | journal = [[Lancet (London, England)]]
  | volume = 365
  | issue = 9464
  | pages = 1073–1086
  | year = 2005
  | month = March
  | doi = 10.1016/S0140-6736(05)71144-2
  | pmid = 15781103
  }}</ref>
 
* '''[[Neurologic dysfunction]]'''
** Patients with serious [[neurologic]] [[dysfunction]] should undergo brain [[imaging]] performed to assess [[CNS]] involvement.<ref>{{Cite journal
| author = [[Andreas Greinacher]], [[Sigrun Friesecke]], [[Peter Abel]], [[Alexander Dressel]], [[Sylvia Stracke]], [[Michael Fiene]], [[Friedlinde Ernst]], [[Kathleen Selleng]], [[Karin Weissenborn]], [[Bernhard M. W. Schmidt]], [[Mario Schiffer]], [[Stephan B. Felix]], [[Markus M. Lerch]], [[Jan T. Kielstein]] & [[Julia Mayerle]]
| title = Treatment of severe neurological deficits with IgG depletion through immunoadsorption in patients with Escherichia coli O104:H4-associated haemolytic uraemic syndrome: a prospective trial
| journal = [[Lancet (London, England)]]
| volume = 378
| issue = 9797
| pages = 1166–1173
| year = 2011
| month = September
| doi = 10.1016/S0140-6736(11)61253-1
| pmid = 21890192
}}</ref>[[Seizure|Seizures]] are treated with [[Antiepileptic drugs|antiepileptic agents]].<ref>{{Cite journal
| author = [[Mini Michael]], [[Elizabeth J. Elliott]], [[Greta F. Ridley]], [[Elisabeth M. Hodson]] & [[Jonathan C. Craig]]
| title = Interventions for haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura
| journal = [[The Cochrane database of systematic reviews]]
| issue = 1
| pages = CD003595
| year = 2009
| month = January
| doi = 10.1002/14651858.CD003595.pub2
| pmid = 19160220
}}</ref>


==References==
==References==

Latest revision as of 02:35, 21 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]

Overview

The mainstay of therapy for hemolytic uremic syndrome (HUS) is supportive therapy. Antibiotic therapy is not recommended among patients with HUS. Hydration and intravenous (IV) isotonic saline replacment decrease the risk of hemolytic-uremic syndrome (HUS). Patients with HUS who have significant clinical bleeding or who require an invasive procedure should receive platelet transfusions.

Medical Therapy

HUS

References

  1. Silviu Grisaru (2014). "Management of hemolytic-uremic syndrome in children". International journal of nephrology and renovascular disease. 7: 231–239. doi:10.2147/IJNRD.S41837. PMID 24966691.
  2. C. S. Wong, S. Jelacic, R. L. Habeeb, S. L. Watkins & P. I. Tarr (2000). "The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections". The New England journal of medicine. 342 (26): 1930–1936. doi:10.1056/NEJM200006293422601. PMID 10874060. Unknown parameter |month= ignored (help)
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  22. Andreas Greinacher, Sigrun Friesecke, Peter Abel, Alexander Dressel, Sylvia Stracke, Michael Fiene, Friedlinde Ernst, Kathleen Selleng, Karin Weissenborn, Bernhard M. W. Schmidt, Mario Schiffer, Stephan B. Felix, Markus M. Lerch, Jan T. Kielstein & Julia Mayerle (2011). "Treatment of severe neurological deficits with IgG depletion through immunoadsorption in patients with Escherichia coli O104:H4-associated haemolytic uraemic syndrome: a prospective trial". Lancet (London, England). 378 (9797): 1166–1173. doi:10.1016/S0140-6736(11)61253-1. PMID 21890192. Unknown parameter |month= ignored (help)
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