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Hemolytic Uremic Syndrome 431.e3

○ After appropriate volume expansion, if • Chronic glomerulonephritis/protein-losing Prevention
nephropathy
urine output deficient and blood pres- • Poorly healing cutaneous lesions For the cases initiated by ingestion of STEC
VetBooks.ir output with mannitol 0.5 g/kg IV over Recommended Monitoring inadequately cooked beef from diet. Diseases and Disorders
sure adequate, attempt to increase urine
0157:H7, prevention depends on removal of
30 minutes or, if intravascular volume
Technician Tips
overload, furosemide 0.5-1 mg/kg/h IV
quality, extremity temperature, central venous
constant-rate infusion • Perfusion parameters such as mentation, pulse Gloves should be worn when examining lesions.
• Avoid antibiotics because several classes (e.g., pressure, lactate, and hematocrit/total protein
fluoroquinolones, trimethoprim-sulfadiazine, should be monitored frequently (e.g., q 6h). Client Education
beta-lactams) lead to increased expression of • Blood urea nitrogen, creatinine, electrolytes Warn owners that feeding raw contaminated
the Shiga toxin and have been associated with • Platelet count meat is thought to be responsible for the
increased risk of developing HUS when used • Urine output outbreaks in greyhound dogs.
during the diarrhea phase in children. • Blood pressure
• Azithromycin decreases Shiga toxin expres- • Pain SUGGESTED READING
sion in vitro and no cases of HUS were Fakhouri F, et al: Haemolytic uraemic syndrome.
diagnosed in children receiving this antibiotic PROGNOSIS & OUTCOME Lancet 390:681-696, 2017.
during the diarrhea phase. It is suggested that
azithromycin be considered if an antibiotic • Often a fatal disease if the patient is anuric ADDITIONAL SUGGESTED
is mandatory. and the owner cannot afford referral to a READINGS
• Avoid nonsteroidal antiinflammatory drugs dialysis center Carpenter JL, et al: Idiopathic cutaneous and renal
and antimotility agents. • Survivors may have chronic kidney disease glomerular vasculopathy of greyhounds. Vet Pathol
• Analgesia is essential; opioids such as fentanyl or glomerular disease. 25(6):401-407, 1988.
or morphine should be considered. Holloway S, et al: Hemolytic uremic syndrome in
PEARLS & CONSIDERATIONS dogs. J Vet Intern Med 7(4):220-227, 1993.
Chronic Treatment Kruth SA: Gram-negative bacterial infections. In
Hypertension may be treated with amlodipine Comments Greene CE, editor: Infectious diseases of the
0.1-0.25 mg/kg PO q 24h; up to maximum of • Early intensive therapy with intravascular dog and cat, ed 3, St. Louis, 2006, Saunders, pp
320-330.
0.5 mg/kg. fluids is the key to survival and perhaps Noris M, et al: STEC-HUS, atypical HUS and TTP
prevention after initial sign of hemorrhagic
Nutrition/Diet diarrhea is noted. are all diseases of complement activation. Nat Rev
Nephrol 8:622-633, 2012.
Nutritional support as needed is based on require- • Pharmacologic targeting of complement with
ments and available routes of administration. the anti-C5 monoclonal antibody eculizumab RELATED CLIENT EDUCATION
is being used with some success in humans
Possible Complications with HUS. SHEET
• Hemorrhage from severe thrombocytopenia • There are no data to indicate that plasma Raw Food Diets and Associated Risks
or DIC exchange (used for removing antibodies
• Bacterial translocation and sepsis from in a similar syndrome, thrombotic throm- AUTHOR: Maureen A. McMichael, DVM, MEd,
intestinal mucosal disruption bocytopenic purpura, in humans) has any DACVECC
• Systemic hypertension benefit. EDITOR: Joseph Taboada, DVM, DACVIM

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