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Abstract: SA-PO079

Late-Onset Shiga Toxin-Related Hemolytic Uremic Syndrome

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Wall, Norman, Louisiana State University, New Orleans, Louisiana, United States

Group or Team Name

  • Section of Nephrology, Dept of Medicine; LSU Health New Orleans.

HUS may occur after improvement of gastrointestinal tract symptoms, andl we should carefully monitor for the onset of HUS, even if the patient has few symptoms.

Case Description

A 34-year-old male transferred to the University Medical Center New Orleans for evaluation of nephrotic range proteinuria and edema. He presented to his local hospital ED with edema and bloody diarrhea that started in November and resolved in April after a course of antibiotics for acute pancreatitis. He reported weakness and fatigue, an 11-pound weight loss, nose bleeds, and shortness of breath for about 5 days prior to admission. His initial treatment consisted of 5 UPRBC, and diuresis. He developed an AKI, and a renal biopsy was performed that was consistent with Post-Infectious Glomerulonephritis.
WBC 17.0 10’3/uL, Hgb 7.5 gm/dl, Hct 23.4 %, Plt 667 10’3/uL, Schistocytes 3+, Retic Count 7.5%, C3 Compliment 172 mg/dL, C4 Compliment 35 mg/dL, LDH 433, ADAMTS 13 Activity 73.9%, Urine PH 5.0, SG >1.030 Glucose >500 mg/dL, Bld 0.03 mg/dL, RBC 3-5, Protein 100 mg/dL, Prt/Cr ratio 1,100, Hep B, Hep C, HIV all negative, Na 139 mmol/L, K 3.9 mmol/L, Cl 106 mmol/L, CO2 mmol/L, BUN mg/dL, Cr 1.24 mg/dL, ANA neg, haptoglobin <30 mg/dL.


Shiga toxin-related hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy that typically begins days after clinical gastroenteritis caused by Shiga toxin–producing Escherichia coli and is characterized by a triad of thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. The patient in this case report presented with few subjective symptoms, and the onset of HUS may not have been noticed if the patient was not hospitalized. In conclusion, this abstract describes a patient with late onset HUS that was preceded by the appearance of minimal gastrointestinal and HUS symptoms, who was successfully treated with IV fluid therapy and corticosteroids alone. In adults with an EHEC infection, HUS may occur after improvement of gastrointestinal symptoms. Careful monitoring of HUS symptoms and changes in chemistry, hematology and urinalysis findings is recommended, regardless of the severity of gastrointestinal symptoms.