Hemolytic Uremic Syndrome (HUS)

Diagnosis

Diagnosing hemolytic uremic syndrome (HUS) involves a detailed physical examination and several laboratory tests to confirm the condition and identify its cause. These tests help determine the extent of kidney involvement and whether the red blood cells are being destroyed.

• Blood tests: These tests can show damaged red blood cells, a low platelet count, and anemia due to red blood cell destruction. They can also detect elevated levels of creatinine, a waste product that increases when the kidneys aren’t functioning properly.

• Urine test: A urine analysis checks for unusual levels of protein, blood, and any signs of infection that might indicate kidney problems.

• Stool sample: This test looks for harmful bacteria such as E. coli, which can cause certain forms of HUS.

If the underlying cause of hemolytic uremic syndrome isn’t immediately clear, additional tests may be performed to rule out other potential causes or complications.

Treatment

Hemolytic uremic syndrome requires hospital care to manage symptoms and support kidney function. Treatment focuses on replacing fluids, restoring electrolytes, and addressing complications caused by kidney failure or damaged blood cells.

Supportive care

• Fluid and electrolyte replacement: Lost fluids and minerals are replaced intravenously to maintain hydration and balance.

• Nutritional support: In some cases, nutrition may be provided through a vein until the kidneys recover.

Transfusions

• Blood transfusions: Red blood cell transfusions may be needed to treat anemia and improve oxygen levels in the body.

Medicines

• Blood pressure medicines: If HUS leads to kidney damage, medicines that lower blood pressure can help protect the kidneys and prevent further injury.

• Complement-inhibiting medicines: For atypical hemolytic uremic syndrome (aHUS), drugs like eculizumab (Soliris) and ravulizumab (Ultomiris) can prevent further blood vessel damage. Anyone receiving these medicines must be vaccinated against meningitis due to the risk of infection.

Surgery and procedures

• Kidney dialysis: When the kidneys fail to remove waste and excess fluid, dialysis helps clean the blood until kidney function improves. In severe cases, long-term dialysis may be required.

• Plasma exchange: This procedure replaces the patient’s plasma with healthy donor plasma using a machine, helping remove harmful substances and restore proper blood function.

• Kidney transplant: In cases of severe or permanent kidney damage, a kidney transplant may be the best long-term treatment option.

Early diagnosis and prompt hospital care greatly improve the chances of recovery from hemolytic uremic syndrome and reduce the risk of long-term kidney complications.