Hemolytic uremic syndrome: current pathophysiology and management

The combination of microangiopathic hemolytic anemia, thrombocytopenia, and renal failure, referred to as hemolytic uremic syndrome (HUS), is one of the main causes of acute renal failure in children. In most patients, infection with verotoxin-producing E. coli (VTEC, serotype O157:H7) precedes the development of bloody diarrhea (D+) characteristic of enteropathic HUS cases. In a minority, however, neither the enteropathogenic bacteria nor bloody diarrhea (D-) are documented. Despite that the pathogenesis of the two varieties remains unclear, clinical differentiation between D+ and D- HUS is extremely important to the final outcome. A more severe course, which may result in end stage renal disease, is frequently observed in the D- group.