Hemolytic-uremic syndrome history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [3], Anila Hussain, MD [4] Parth Vikram Singh, MBBS[4]

Overview

The majority of patients with hemolytic uremic syndrome (HUS) are asymptomatic. High-risk STEC infection often begins with abdominal pain, vomiting, and fever, followed by diarrhea that may become bloody 1 to 3 days after onset. Early diagnosis is important. Stool testing should be obtained from all patients with hematochezia and from children with nonbloody diarrhea accompanied by tenesmus or severe abdominal pain. The absence of fever does not exclude STEC infection. It usually start with gastrointestinal prodrome including bloody diarrhea and fever that may occur 2-7 days before the onset of renal failure. Other symptoms include nausea, vomiting, abdominal pain and swelling, decreased urination, fatigue, irritability, and swelling of body.

History and Symptoms

• The hallmark of HUS is bloody diarrhea (dysentery).
• A positive history of bloody diarrhea and abdominal tenderness is suggestive of HUS. The most common symptoms of HUS include bloody diarrhea , fever and gastrointestinal complaints. The classic triad of signs/symptoms involves microangiopathic hemolytic anemia, renal failure, and thrombocytopenia.

Common Symptoms

Symptoms of HUS include:

• Bloody diarrhea
• Abdominal pain
• Decreased urination or blood in urine
• Vomiting
• Fatigue
• Irritability
• Abdominal swelling
• Blood in the urine (hematuria)

Less Common Symptoms

Less common symptoms of HUS include:

• Swollen face
• Swollen limbs
• Seizures

Common presenting symptoms of high-risk STEC infection and evolving STEC-HUS include bloody diarrhea, abdominal pain, vomiting, painful defecation or tenesmus, and decreased urine output as HUS develops. Fever is reported in 30 to 50% of infected children but is often absent at presentation.