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On Their Level: Hemolytic-Uremic Syndrome (HUS)

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On Their Level is an opportunity to explain complicated diagnoses through the eyes of a child. With the help of expert specialists at IU School of Medicine, On Their Level gives perspective on big issues in medicine so that our tiniest patients can understand.

By: Ashley Wilson and Myda Khalid, MD, Associate Professor of Clinical Pediatrics

The hot summer months bring on a new world of adventures for kids. Summer means swimming, playing outside for hours, taking family vacations, and visiting the many fairs and festivals that the state of Indiana has to offer. In the summer months, not many people are thinking about getting sick, but a disease called hemolytic-uremic syndrome, or HUS, is actually more common during the summer months. Most cases of HUS are from a nasty bug called E. coli. Very rarely HUS can be because the body decides to attack itself, in this case, it is called atypical HUS. In this article we will talk about HUS that happens because of the silly E. coli.

HUS is caused by the E. coli bacteria, a disease that translates more simply into being a nasty case of diarrhea. Kids (and adults) with E. coli spend a lot of time in the restroom because of diarrhea, are often very thirsty, have stomach pains, and are weak. Some children may even have a fever. E. coli is very similar to the common stomach bug, it just affects your body differently. Those who get HUS will start out with all of the same symptoms of E. coli, the differences start a few days later when that diarrhea turns (in most cases) into bloody diarrhea. If at any time a child is experiencing bloody diarrhea, the doctors in Pediatric Nephrology at Indiana University School of Medicine recommend going to see their primary care physician as soon as possible. Of those kids that get bloody diarrhea, about 10-15% of them will get HUS. While this may seem like a very small percentage, the children who do get sick need to be urgently cared for by kidney specialists in the hospital.

We get infected by the E. coli bug when we end up eating some of the bugs by mistake. Sometimes E. coli is mixed in with the food we eat, and other times the germs are stuck on our hands and then when we eat something or put our hands in our mouth, the germs jump inside our mouth and enter our body.

Why is HUS so common in the summer? We are not completely sure we have the answer to that, but here are some theories. In the summer, children are out and about playing with or around animals that carry the E. coli germs. Some pools may not have enough chlorine to kill the germs that cause E. coli and HUS, so when kids swallow pool water, it can make them sick. Another common reason is lack of hand washing at events like fairs and festivals. Fairs and festivals commonly have animals for show and petting zoos, coming in contact with their fecal matter and then not washing your hands properly is another way that kids can get sick with this. Many times the germs are in the food being eaten, with the typical culprits being uncooked or undercooked foods. In the past, foods such as undercooked hamburger meat, strawberries, spinach, raw flour and sprouts have had E. coli in them that made people sick.

What makes HUS so serious is that the disease causes damage to the tiny blood vessels inside your kidneys, an organ in your body that filters blood to remove waste and excess water. Primary care doctors will do a blood draw on children who they suspect to have HUS, which tells them how the kidneys are working. Damage to those blood vessels can often affect the kidneys ability to filter the blood and can cause kids to need dialysis. Dialysis involves the use of a special machine that can remove the extra salt, waste and water from the blood. Over half of the children with HUS might need dialysis and many will need a blood transfusion. For these reasons, every child with HUS must be hospitalized.

While staying in the hospital, doctors are able to monitor kids to make sure that they’re getting everything they need to heal. There aren’t any special medicines or cures for HUS, your body just needs time to heal and get better – much like with a cold. One of the best parts about HUS is that it doesn’t last forever. Most children will stay in the care of a pediatric nephrologist for several years, just to make sure that their kidneys are staying healthy.

When the summer months come around, there’s no reason to stay outside and hide—go out and enjoy the pools and fairs. Just remember to keep your hands clean and avoid drinking bad water from pools or lakes. Healthy kidneys mean happy lives.

If you have questions about HUS, please contact Ashley Wilson ( 

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
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Ashley Dummer

Ashley Dummer is a Communications Specialist in the Department of Pediatrics. She has worked in Pediatrics since graduating with her degree from Indiana University.