Tag Archives: renal disease

April PDF digest ready to go

This month‘s newsletter has some helpful resources for parents of children of all ages.  Also a reminder from Islington borough of London that children should be at school if they have minor illnesses.  Everyone gets muddled up with HSP and ITP so we’ve put together a comparison table. Do leave comments below…

August 2020 PDF

Acute Kidney Injury (AKI) by Alex Argyropoulos this month: risk, recognition and management.  Surgical update on hernias, the difficulties of wearing masks for people who stutter and a helping hand from Harry the Hound for children worried about going back to school after covid.

Please do leave comments below.

August 2019 Paediatric Pearls newsletter uploaded

More on the coca-cola urine story this month, NF type I, cerebellar ataxia and restless legs syndrome.  Do leave comments below.

June 2019 newsletter

Possible causes of macrocephaly this month.  Also the start of a new series on causes of coca-cola coloured urine and updates on safeguarding CPD requirements and the terminology of children “in care”.  Do leave comments below:

November 2018 published

STIs, sexual abuse, eating disorder and haemolytic uraemic syndrome this month.  Do leave comments below:

Haemolytic Uraemic Syndrome (HUS)

With thanks to Dr David Gardiner, one of our current paediatric FY2 doctors at Homerton University Hospital, for updating us on HUS.

News story in 1999
News story from 2018.  Less than 3% of patients die of HUS but 20-30% experience adverse renal outcomes.  Think about it in children with bloody diarrhoea and, often, no fever.

Presentation:

  • Profuse diarrhoea that typically turns bloody after 1-3 days
  • Abdominal pain (crampy)
  • Vomiting
  • Fever (sometimes)
  • Oedema
  • Reduced urine output (abrupt onset) but also polyuria/normal urine output (rarer)
  • Neurological complications: seizure, coma, cranial nerve palsies, confusion, hallucinations
  • Classic triad – anaemia, uraemia and thrombocytopaenia
  • Most common in children under the age of 5

Investigations:

  • B/P – hypertension
  • Blood film: Fragmentation and signs of haemolysis (Coombs test negative)
  • Raised WCC and neutrophils, low platelets, low Hb
  • Raised LDH
  • Clotting screen typically normal (cf DIC)
  • Raised bilirubin, low albumin
  • Urea and creatinine raised
  • Stool for PCR E.Coli

Management:

  • Refer to secondary care urgently
  • Strict input/output fluid monitoring
  • Correction of anaemia
  • Correction of electrolyte imbalances
  • Antihypertensive therapy if required
  • Dialysis
  • Furosemide to induce diuresis
  • Report to PHE – can’t go back to school until 2 negative stool samples

More resources:

Kidney Research website on HUS

https://patient.info/doctor/haemolytic-uraemic-syndrome-pro#ref-8