Subject: Re: Blood in urine
Forum: The Urology Forum
Topic Area:
Posted by HFHS M.D.-JJ on March 11, 1998 at 08:58:30:
In Reply to: Blood in urine posted by Andrew on February 12, 1998 at 21:29:18:

3 y.o. male patient recently diagnosed with e.coli infection and released to parents care from hospital now presents with blood in urine and has been referred to ER and placed into intensive care.
I have read in "Merck Manual," and this sounds consistent with Hemolytic-Uremic Syndrome.
I read that dialysis may be indicated in this situation. Is this the current treatment recommendation, and is other adjunctive treatment recommended?
What is the prognosis in this situation?
Thank you.

Dear Andrew,

Hemolytic Uremic Syndrome (HUS) is characterized by a group of disorders namely;
Microangiopathic Hemolytic Anemia
Decrease in the red blood cell count and hemoglobin secondary to consumption and destruction of red blood cells in small blood clots that form in the small and medium sized arteries in the kidney.
Thrombocytopenia
Decrease in the platelet count secondary to consumption of the platelets ( the component in your blood that is partially responsible for blood clot formation) in blood clots of the small and medium sized arteries of the kidney.
Acute Renal Failure
Kidney failure due the thrombotic microangiopathy ( formation of blood clots in the small blood vessels) that takes place with HUS.

There are two forms of HUS; a diarrheal form that is caused by cytotoxin producing bacteria most commonly E. Coli or Shigella Dysenteriae , and a non-diarrheal form usually related to infections with Streptococcus Pneumoniae and many viruses, or secondary to malignancy, renal transplantation, or certain medications.

The treatment of HUS may require hemodialysis for the acute renal failure or supportive management of the renal insufficiency depending on the extent of kidney damage/involvement. Treatment also includes possible blood transfusion to address the anemia, and possible platelet transfusion to treat the thrombocytopenia in cases where there is symptomatic bleeding, and possible plasma transfusion.

The prognosis of HUS is worse with the non-diarrheal forms of the disease, in children less than a year of age, and those with prolonged anuria (not forming urine), severe hypertension, or severe central nervous system disease.

From the information you provided in your question, you have not stated whether the E. Coli infection was diagnosed as a urinary tract infection, or whether it was a gastrointestinal infection with diarrhea. In addition, there is no mention as to the any possible kidney failure, thrombocytopenia, or anemia. Therefore it is possible that the patient has urosepsis which is essentially an overwhelming urinary tract infection that has now spread to the blood stream with need for monitoring and care, intravenous (IV) hydration, and IV antibiotics in an ICU setting. Urosepsis may have hematuria (blood in the urine), but hemolytic uremic syndrome is usually not associated with hematuria. In addition, if the patient had a urinary tract infection or urosepsis, he will require further urologic workup and tests.

Please keep in mind that I am not trying to establish a diagnosis based on my limited information about the patient you presented, but rather have attempted to answer your questions regarding HUS since it appears to be a concern to you. I hope the 3 y.o. boy you presented is doing well.

This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568). We can also arrange local accommodations through this number if this is
your need. Please bring any physicians notes and lab test results that
you may be able to obtain. These will help us greatly.
Sincerely;
HFHS M.D.- JJ
* Keyword: Hemolytic Uremic Syndrome

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