Hemolytic uremic syndrome (HUS) is something we have probably all cared for at some point in our training if not multiple times. We are aware of the need for supportive treatment until the complications of the shiga-toxin producing E.coli have run their course and usually this has meant fluid restriction with the intent of avoiding fluid overload in these oliguric or anuric patients. Would you ever consider volume expansion rather than restriction at the onset of HUS? Ardissino et al. would, (10.1542/peds.2015-2153) as a result of a fascinating and well-done study where they used early volume expansion rather than fluid restriction to insure adequate circulating volume to decrease hypoxic/ischemic tissue damage.
The authors compared patients who received such fluid expansion with those in prior years who were fluid restricted and much to our surprise (and maybe the investigators as well), the early fluid bolusing resulted in improved short-term and long –term outcomes with less need for dialysis, intensive care stay or extra-renal sequelae. The authors propose a mechanism for the better outcome which involves reduced thrombi formation and in turn less ischemic tissue damage—but you need to read the study to learn more.
Intensivist and Editorial Board member Dr. David Cornfield weighs in as well on the surprising results in this study with an accompanying commentary (10.1542/peds.2015-3524) that is also a must-read. After considering the results in this study and the commentary—would you go with the flow of what you have read and change how you initially manage your HUS patients? Share with us your thoughts by responding to this blog, sending an e-letter or posting a response on our Facebook or by Twitter.
