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