Clinical scenario: Reduced urine out put | bloody diarrhea | Schistocytes
A 7-year-old boy presents with reduced urine output for 2 days. One week earlier, he had bloody diarrhea. Examination shows mild edema and blood pressure of 145/95 mmHg. Urinalysis reveals hematuria and proteinuria.
Investigations:
- Hb: 8.5 g/dL
- Platelets: 65 × 10⁹/L
- Creatinine: 3.2 mg/dL
- Blood film: schistocytes
- LDH: raised
What is the most appropriate management?
A. Steroids
B. Renal biopsy
C. Supportive care
D. Plasma exchange
E. Antibiotics
Correct answer & Explanation:
Correct answer: C. Supportive care
Explanation:
The child has typical hemolytic uremic syndrome (HUS) due to Shiga toxin–producing E. coli infection. The triad is:
- Microangiopathic hemolytic anemia
- Thrombocytopenia
- Acute kidney injury
Management is mainly supportive:
- Monitor fluid balance
- Correct electrolyte abnormalities
- Control hypertension
- Dialysis if required
Why not others?
- Steroids → no role in typical HUS
- Renal biopsy → not needed with classic presentation
- Plasma exchange → reserved for atypical HUS/TTP
- Antibiotics → generally avoided in Shiga toxin HUS
Key point: Bloody diarrhea followed by AKI + thrombocytopenia + hemolysis = HUS → supportive management.
