In this presentation provided by the nation's foremost food poison law firm - Marler Clark, Hemolytic Uremic Syndrome (HUS) is explained. HUS is a rare and highly dangerous result of an E. coli infection and can result in acute kidney failure

1. Long-Term Health Implications Hemolytic Uremic Syndrome (HUS)

2. Normal Kidney Structure and Function

6. Normal Kidney Courtesy of JC Jennette, MD, UNC-Chapel Hill The Human Body, Dorling Kindersly Limited, London 1995

9. Structure: Kidney Biopsy Normal Glomerulus Acute HUS Glomerulus Courtesy of JC Jennette, MD, UNC-Chapel Hill

15. HUS Pathogenesis Adapted from Stewart CL, Pediatr Rev, 1993 A: Normal Glomerular blood vessel B: (-) charged endothelial cell (+) charged Platelet ( ) C: Loss of (-) charge and PGI 2 due to endothelial damage D: Fibrin/platelet thrombi formation A B C D

16. The Kidney in HUS Courtesy of P Tarr MD, Univ of Washington Normal Capillary TMA Capillary Thrombus Expanded subendothelial zone Narrowed lumen Toxin causing injury to endothelial cells

17. Micrograph of TMA in Glomerulus Courtesy of JC Jennette, MD, UNC-Chapel Hill Glomerular Light Microscopy Normal Capillary TMA Capillary Lumen Subendothelial Expansion

18. Micrograph of TMA in Renal Artery Courtesy of JC Jennette, MD, UNC-Chapel Hill Normal Artery TMA Artery Arterial Intimal Thickening Lumen Intimal Expansion Obliterating Lumen

19. Electron Micrograph of Fibrin Clot and Red Blood Cells Fibrin Strands Red Blood Cells Courtesy of P Tarr MD, Univ of Washington

25. Other Organs Involved in Acute HUS Siegler RL, Spectrum of involvement in post-diarrheal hemolytic-uremic syndrome. J Pediatrics, 125(4): 511-518, 1994 Intestine Liver Brain Pancreas Heart / Lung / Other 100 % 40 % 20 % 20 % < 1 % Frequency

29. Six months after HUS 0.5 - Areas of scar formation 115 ml/min/1.73m2 100/60 10 mg/dl 0.2 NL NL NL NL NL Serum Cr GFR BP Urine Protein Urine Prot/Cr

30. 5 Years After HUS: Possible Outcomes III. Significant Hyperfiltration I. None/Minimal Hyperfiltration II. Moderate Hyperfiltration

31. 10-30 Years After HUS Chronic Renal Failure 4.0 NO Maybe? Probable Serum Cr 28 GFR U Prot Elevated BP High