Synopsis
Recognise renal-predominant thrombotic microangiopathy, identify Shiga-toxin infection, distinguish complement-mediated disease and secondary mimics, and provide kidney support or urgent complement blockade safely.
- HUS is a thrombotic microangiopathy characterised by thrombocytopenia, microangiopathic haemolytic anaemia and acute kidney injury, with renal injury often dominating the presentation.
- Shiga-toxin-producing Escherichia coli HUS commonly follows abdominal pain and bloody diarrhoea, but diarrhoea may have resolved before kidney and platelet abnormalities appear.
- Send stool culture and Shiga-toxin PCR promptly and notify microbiology or UKHSA because infection-control and public-health actions extend beyond the individual patient.
Key red flags
Refractory hyperkalaemia, pulmonary oedema, severe acidosis or uraemic complications requires urgent renal replacement assessment.
Investigation priorities
Establish evidence of thrombocytopenic microangiopathic haemolysis.
Management branches
Thrombocytopenia, schistocytes and haemolysis occur with acute kidney injury.
- Call nephrology and haematology, manage fluid, potassium, acidosis, blood pressure, seizures and pulmonary oedema and assess dialysis indications.
- Send stool STEC testing, pre-plasma ADAMTS13, coagulation and complement samples and review pregnancy, drugs, transplant, sepsis and hypertension.
Key medicines
EculizumabThe specialised aHUS service gives the licensed intravenous weekly induction followed by weight-appropriate maintenance, with supplemental doses after specified plasma treatments.
Antihypertensive therapyUse titratable intravenous treatment for a hypertensive emergency and kidney-appropriate oral agents for ongoing control, with targets set by critical care, renal and pregnancy context.