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Shiga toxin-associated HUS — ESENeph MCQ

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HardGlomerulonephritisShiga toxin-associated HUSESENeph

A 34-year-old woman has bloody diarrhoea followed by oliguria and confusion. Haemoglobin is 78 g/L, platelets 42 x 10^9/L and creatinine 318 micromol/L. Blood film shows schistocytes and LDH is markedly raised; coagulation screen is normal. Stool PCR later detects Shiga toxin-producing Escherichia coli. What is the most likely diagnosis?

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Correct answer: B — Shiga toxin-associated haemolytic uraemic syndrome

Microangiopathic haemolytic anaemia, thrombocytopenia and AKI after bloody diarrhoea is typical of Shiga toxin-associated HUS. DIC would usually cause deranged coagulation tests and a different clinical context. Anti-GBM disease causes nephritic urine and pulmonary haemorrhage rather than a diarrhoeal thrombotic microangiopathy. The pearl is that supportive care is central, while antibiotics and antimotility drugs are generally avoided in suspected STEC infection.

Reference: KDIGO supportive care principles; UKHSA STEC guidance