Abstract: FR-PO133

Multisystem Manifestations of Haemolytic Uremic Syndrome: A Pictorial Case Series

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Hartley, Louise J, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  • Butler, Sandra, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  • Stenhouse, Emily J, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  • Reynolds, Ben C, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
Background

We present a comprehensive pictorial case series illustrating the diverse multisystem radiological manifestations of Shiga toxin-producing Escherichia coli Haemolytic Uremic Syndrome (STEC-HUS). STEC-HUS is characterised by haemolytic anaemia, thrombocytopenia and acute renal dysfunction with significant morbidity and mortality.

Methods

We retrospectively reviewed the imaging findings of 148 cases of STEC-HUS in a national paediatric nephrology centre over a 13 year period. The average presenting age was 5.5 years (52% female; 48% male).

Results

Renal: Renal ultrasound was performed in 18.2% of cases, of which a hyperechoic renal cortex was the most common finding (19/27). Three cases of renal cortical necrosis and one case of acquired cystic kidney disease were diagnosed on serial ultrasound and MRI imaging. Gastrointestinal: Abdominal radiography (AXR) was performed in 14.2% of cases, of which colonic wall thickening was the most common finding (14/21). On abdominal ultrasound colonic thickening (12/27) and free fluid (10/27) were the most common findings. One case of bowel ischaemia was diagnosed on MRI. Neurological: Neuroimaging was performed in 8.1% of cases, of which bilateral lentiform nuclei and/or thalamic infarctions were the most common abnormality (5/12). Two patients had multi-territorial infarcts including the first reported case of large vessel arterial thrombosis in HUS on imaging. Hepatobiliary: Two cases of hepatomegaly were seen on abdominal ultrasound. On AXR biliary excretion of contrast media due to renal failure was reported in one case. Haemodialysis-related secondary haemochromatosis was diagnosed on follow-up MRI in two cases. Respiratory: Chest radiography was performed in 21.6% of cases, of which pulmonary oedema was the most common abnormality (7/32). Ocular: Eye ultrasound demonstrated severe vitreous haemorrhages in one case.

Conclusion

This pictorial case series illustrates the imaging findings of common, rare and previously unreported multisystem manifestations of STEC-HUS. Awareness of the role of radiology will aid early diagnosis and subsequent management in this complex disease.