Is your child having a bad stomach ache? It could be Hemolytic Uremic Syndrome (HUS)!

Has your little one been having diarrhea with a stomach ache for a few days? You may even see blood in it. It's normal for you, as a parent, to be very worried when that happens. When you have symptoms like these, it could be more than just a simple stomach ache. Today we're going to talk about a condition that can be serious, but is very treatable if recognized early. That's (Hemolytic Uremic Syndrome) , or (HUS) for short.

What is Hemolytic Uremic Syndrome (HUS)? Let's understand it simply.

Okay, now let's look at what this (HUS) is. Simply put, it's a condition where the tiny blood vessels in our kidneys become blocked . Think of it like a water pipe getting blocked and the water stops flowing. This blockage causes three main things to happen:

1. Your red blood cells are destroyed: In medicine, this is called hemolytic anemia . Red blood cells are what carry oxygen throughout our bodies. So when they are destroyed, the amount of oxygen the body needs decreases.

2. The number of platelets in the blood decreases: This condition is called thrombocytopenia . Platelets are small cells that help our blood clot when we bleed. When these decrease, it becomes difficult to stop bleeding, and bruises can occur all over the body.

3. Kidney damage: This is the most dangerous thing. When the kidneys do not work properly, they are unable to remove waste products that accumulate in the body. This is also called (Acute Kidney Injury - AKI) .

Although HUS can affect anyone, it is most often caused by a bacterial infection , especially Escherichia coli , commonly known as E. coli . This bacteria is the cause of diarrhea, especially bloody diarrhea. However, a syndrome is a collection of symptoms, and HUS can also occur due to other causes than E. coli.

This condition (HUS) can affect not only the kidneys, but sometimes other organs such as the heart and brain. However, it most commonly affects the kidneys.

Most importantly: If you or your child has bloody diarrhea or has diarrhea for more than three days, be sure to see a doctor. If left untreated, HUS can become severe and even life-threatening.

Are there different types of HUS?

Yes, there are several main types of (HUS). Let's learn a little about them:

1. "Typical" (HUS): This is the most common type . It is most often caused by a bacterial infection, especially E. coli, that affects our small intestine and colon.

2. "Atypical" (HUS) (aHUS): This is a bit rarer . It is often genetic, meaning it is passed down from parents to children.

3. "Secondary" (HUS): This type occurs in association with other medical conditions. For example, it can be caused by certain medications, other infections, or pregnancy.

Let's learn a little more about "Atypical" (HUS) (aHUS)

(aHUS) is a very rare condition. It can also cause the same symptoms as the previous one:

• Decreased red blood cell levels.
• Decreased platelet count.
• Sudden kidney failure (acute kidney failure) .
• High blood pressure (hypertension) or inability to control blood pressure.

This condition (aHUS) is usually a genetic disorder . That is, it is caused by certain changes (mutations) in our genes. However, even if this genetic condition exists, it is triggered by some infection, disease, or environmental factor.

How common is (HUS)?

Between 5% and 15% of people who get diarrhea caused by the bacteria (E. coli) will develop HUS . The type called (aHUS) is very rare. It occurs in about one in a million people.

What are the main symptoms of (HUS)?

It is very important that you are aware of these symptoms.

First visible symptoms:

• Diarrhea: Often accompanied by blood.
• Abdominal pain.
• Nausea and vomiting.
• Headache .
• Chills and fever.

Other visible features:

• Easy bruising.
• Pale skin (pallor): The inside of the nose and even the inside of the mouth may become pale.
• Confusion.
• Seizure.
• Stroke-like conditions.
• Rapid heart rate (arrhythmia).

If the condition of (HUS) becomes severe, the destroyed red blood cells can cause blood clots and damage organs like the kidneys. Then the kidneys cannot filter waste products properly. This is what we call (Acute Kidney Injury - AKI) . Here are the symptoms of it:

• Blood in the urine (hematuria).
• Increased levels of toxins in the blood: This can cause discomfort and a feeling of illness.
• High blood pressure.
• Difficulty breathing (dyspnea).
• Edema: Swelling may occur, especially in the legs and ankles.
• Decreased urine output (oliguria).

What are the main causes of (HUS)?

Most cases of HUS are caused by certain strains of the E. coli bacteria. These bacteria produce a toxin called Shiga toxin . This toxin damages the lining of our small intestine and causes diarrhea. This toxin also enters the bloodstream, destroying red blood cells and damaging the kidneys.

You are more likely to get an E. coli infection from:

• Undercooked meats: especially beef, ground beef.
• Unpasteurized milk and fruit drinks: Pasteurization is a gentle heating process that kills harmful substances like bacteria.
• Unwashed, dirty fruits and vegetables.

These toxin-producing E. coli strains are also called Shiga toxin-producing E. coli (STEC) . The most common STEC strain in North America is E. coli O157:H7 .

Very rarely, certain medications and substances can also cause "secondary (HUS)". Examples:

• Anti-cancer drugs (Chemotherapy drugs): such as (bleomycin), (cisplatin), (gemcitabine).
• Immunosuppressant drugs: such as (cyclosporine), (tacrolimus).
• Quinine: A medicine for malaria.
• Some drugs : (oxymorphone), (ecstasy), (cocaine).

Is (HUS) contagious?

No, HUS is not contagious.

However, E. coli bacteria can be transmitted. This bacteria can be transmitted through contaminated food or drink, or by coming into contact with the feces of a person or animal with diarrhea infected with E. coli. Therefore, it is important to be very careful about cleanliness.

Who is most likely to develop (HUS)?

Although anyone can develop HUS, the following people are at higher risk:

• For young children under 5 years old.
• For those with a weak immune system (immunocompromised).
• If someone in your family has had HUS before (especially aHUS).
• If you get an E. coli infection: Especially from things like undercooked meat and unpasteurized milk.
• Direct contact with someone who has diarrhea caused by (E. coli).

How do you know if you have (HUS)? (Diagnosis)

When you see a doctor, he or she will do these things:

• Ask about your medical history .
• Ask about your family medical history .
• A physical examination is performed.

If these things raise suspicion of a condition called (HUS), the doctor will order several more tests.

What kind of tests are done?

• Urinalysis: A sample of your urine is taken and checked for protein or blood.
• Blood test: A blood sample is taken to check things like red blood cell count, platelet levels, and how well your kidneys and liver are working.
• Stool test: A stool sample is taken and checked for the presence of bacteria that cause HUS, such as E. coli O157.
• Genetic testing: Sometimes, a sample of your blood may be sent for genetic testing. This can help determine whether you have a genetic condition like aHUS and what treatment is best for you.
• Kidney biopsy: This involves taking a small piece of the kidney and examining it under a microscope to see how much damage has been done to the kidneys and what caused it. Not everyone needs this.

How can tests confirm that you have HUS?

• From urine tests: If there is blood or protein in the urine.
• Blood tests: If red blood cell and platelet levels are low, or if values ​​indicating kidney function (such as creatinine) are elevated.
• Stool tests: If bacteria like (E. coli O157) are found.
• Kidney biopsy: Specific damage to the kidneys can be seen.

How is (HUS) treated?

If you are diagnosed with HUS, you will need to be hospitalized and treated. Treatment options include:

• Intravenous (IV) fluids and/or tube feeding (enteral nutrition): This helps to prevent dehydration and provide necessary nutrition.
• Medications:
• They try to reduce the damage to the kidneys by giving blood pressure-lowering medications (antihypertensives) .
• People with aHUS may be given specific medications such as eculizumab or ravulizumab . Before starting these medications, it is important to get vaccinated against meningococcal and pneumococcal diseases, as these medications increase the risk of developing those diseases.
• You may need to take antibiotics for at least two weeks.
• Blood transfusions: Giving red blood cells and platelets to someone with (HUS) is very important. Red blood cells reduce symptoms of anemia, such as shortness of breath and rapid heartbeat. Platelets help the blood clot properly, reducing bleeding and bruising.

If the kidneys are severely damaged, dialysis may be needed to clean the blood until the kidneys recover. If the kidneys fail completely due to HUS, a kidney transplant may be necessary.

Can HUS be completely cured?

Yes, many people recover from HUS without permanent damage to their health.

However, some people, especially young children, may develop mild chronic kidney disease (CKD) in 20% to 50%. End-stage kidney disease (ESK) can develop in 3% to 5%. Studies show that CKD affects about 45% of adults.

More than 85% of people who develop HUS fully recover their kidney function. However, even if they recover completely, there is a small chance that they will develop high blood pressure or other kidney problems in the future.

Can HUS be prevented?

Here are some things you can do to help prevent E. coli infection, a major cause of HUS. These are very important for you and your family:

• Avoid swimming in dirty places (lakes, rivers), especially if you think the water has high levels of bacteria.
• If you have diarrhea, don't go swimming.
• Avoid drinking unpasteurized (raw) beverages (milk, fruit juice).
• Always thoroughly clean kitchen utensils (knives, forks, spoons) and food preparation areas (counters, cutting boards, dishes).
• Cook eggs and ground meats thoroughly to an internal temperature of at least 71 degrees Celsius (160 degrees Fahrenheit), and poultry to an internal temperature of 74 degrees Celsius (165 degrees Fahrenheit).
• When defrosting meat, place it in the microwave or refrigerator. Do not defrost it in a food preparation area or in hot water.
• Keep raw and cooked foods separate.
• Wash your hands thoroughly with soap and hot water before eating, after using the bathroom, after changing small children's nappies, and after touching farm animals.

Just think, by following these simple steps, you can protect yourself from a serious situation like this.

What can you expect if you have (HUS)?

With proper diagnosis and treatment, most people with HUS make a full recovery without permanent damage to their health. However, there is a risk of developing high blood pressure or other conditions that affect the kidneys in the future.

Severe cases of HUS, especially if they affect other organs, such as the brain, can be fatal if left untreated.

What are the chances of surviving (HUS)?

With proper diagnosis and treatment, more than 90% of people survive HUS. So it's important not to panic and seek medical advice quickly if you have symptoms.

How do I take care of myself?

If you or your child has severe diarrhea, it is important to try to rehydrate. Rehydration drinks, such as Jeevani, can help replace lost electrolytes. Babies and young children may need to be given breast milk or formula. Ask a doctor about the best way to keep your child hydrated.

When should I see a doctor?

See a doctor immediately if you have these symptoms:

• Bloody diarrhea.
• Diarrhea that lasts more than three days.
• Body swelling.
• Skin that bruises easily.
• Severe fatigue.

What questions should I ask the doctor?

You can ask the doctor these questions:

• How do you confirm if I have Hemolytic Uremic Syndrome?
• How did I get Hemolytic Uremic Syndrome?
• If I don't have Hemolytic Uremic Syndrome, what other medical condition could I have?
• What treatments do you recommend?
• Will my kidneys be permanently damaged?
• Will I develop high blood pressure or other kidney problems in the future?

What is the triad of Hemolytic Uremic Syndrome?

A triad is a combination of three main symptoms that indicate a certain medical condition.

The Hemolytic Uremic Syndrome triad includes:

1. Damage to your red blood cells (microangiopathic hemolytic anemia) .

2. A gradual decrease in the number of platelets in your blood (thrombocytopenia) .

3. Acute kidney injury.

If I have diarrhea, does that mean I have Hemolytic Uremic Syndrome?

Just because you have diarrhea doesn't mean you have Hemolytic Uremic Syndrome. However, if you have bloody diarrhea, or if your diarrhea is severe (to the point of watery diarrhea or lasting more than three days), you should definitely see a doctor.

What is the difference between (Hemolytic Uremic Syndrome) and (Thrombotic Thrombocytopenic Purpura - TTP)?

Hemolytic Uremic Syndrome (HUS) and Thrombotic Thrombocytopenic Purpura (TTP) are two similar conditions. In TTP, blood clots form in small blood vessels. Although doctors used to group HUS and TTP together, they are now considered separate conditions.

Finally, things to remember (Take-Home Message)

Diarrhea is often a short-term, but uncomfortable, condition. It usually gets better in a day or two. However, if you have bloody diarrhea, or if you have diarrhea for more than three days, along with feeling tired, pale, or passing less urine when you go to the bathroom, it's time to see a doctor right away.

A condition called Hemolytic Uremic Syndrome can severely damage your kidneys and affect other organs. The sooner you get treatment for this, the less likely it is that your kidneys will be damaged in the long term. So, be aware of the symptoms, take care of your hygiene, and seek medical advice if you have any concerns. Your health is very important to you!

` Hemolytic Uremic Syndrome, HUS, Kidney Disease, Diarrhea, E. coli, Red Blood Cells, Platelets, Child Health