What initial management steps should be taken for a patient presenting with suspected HUS?

Initial management steps for suspected haemolytic uraemic syndrome (HUS) include:

• Recognise the potential diagnosis in patients, especially children, presenting with acute onset of bloody diarrhoea or confirmed Shiga toxin-producing Escherichia coli (STEC) infection, as these are common triggers for HUS.
• Arrange emergency hospital admission if the patient is systemically unwell, shows signs of severe dehydration, shock, or has suspected serious complications such as HUS.
• Perform a thorough clinical assessment focusing on hydration status, urine output, and signs of pallor or lethargy to detect early features of HUS and acute kidney injury.
• Initiate supportive care including careful fluid management to avoid both dehydration and fluid overload, monitoring urine output closely.
• Seek specialist advice promptly, particularly from nephrology or paediatric specialists, for monitoring and management of HUS.
• Investigate for acute kidney injury with serum creatinine and urine dipstick testing, and consider early referral for renal support if indicated.
• Avoid antibiotics and antimotility agents in suspected STEC infection as they may worsen HUS risk.

These steps aim to stabilise the patient, prevent progression of renal injury, and facilitate early specialist intervention.

References: NICE CG84, NICE CKS, NICE NG148