The hemolytic-uremic syndrome: spectrum of severity and significance of prodrome

Abstract

A review of our experience with the hemolytic-uremic syndrome (HUS) illustrates a broad spectrum of severity. Comparison of this experience with that in other parts of the world leads to the following conclusions: (1) Nondiarrheal HUS may be sufficiently different from postdiarrheal HUS to warrant separate consideration in clinical studies. (2) The Netherlands more closely resembles California than Argentina in having patients with less severe acute renal disease and a more favorable outcome. (3) In California, with no specific therapy aimed at combating intravascular coagulation, even oliguric or anuric postdiarrheal disease has a good prognosis for survival (96%); the prognosis for recovery of normal renal function is good in the large majority of patients oliguric or anuric for two weeks or less (94%), but it is guarded in those with a longer period of renal shutdown (57%). (4) Patients with nonoliguric disease have an excellent prognosis for complete recovery. (5) Very mild and even clinically inapparent cases exist and appear to be part of the spectrum of the same process responsible for severe HUS.