Hemolytic Uremic Syndrome and Gallbladder Disease in Pediatric Patients

Background Hemolytic uremic syndrome (HUS) is a common condition in pediatric patients, and it may manifest with many gastrointestinal symptoms, such as abdominal pain, vomiting, and diarrhea. There is increasing reason to believe that this condition also affects the gallbladder. We report on the frequency of gallbladder disease in pediatric patients who were diagnosed with HUS in our hospital over a 20-year period. Methods Electronic medical records were examined for all patients aged 0-21 years who were diagnosed with HUS between January 2000 and April 2021 and had abdominal imaging performed at Cook Children's Medical Center. To be included, patients had to have had abdominal imaging around the time of HUS diagnosis. Records of patients meeting inclusion criteria were reviewed for information related to HUS diagnosis, gastrointestinal disease, and signs of gallbladder disease. Basic descriptive analysis was used to explain the characteristics of the study population, including frequency and percentages for nominal variables and medians and ranges for non-nominal variables. Results Seventy-nine patients met inclusion criteria. Of these, 69 (87%) patients suffered from gastrointestinal diseases or symptoms. Thirty-three (42%) patients had signs of gallbladder disease, and 86% of these signs occurred within 1 week of HUS diagnosis. The median time from HUS to gallbladder disease was 1 day. Conclusions The present study is the first to systematically study the link gallbladder disease with HUS in pediatric patients, and it provides strong evidence for a connection. Though the current mechanism of this disease association is still unknown, the hemolytic process during HUS is thought to be the underlying cause for gallbladder disease manifestations. It is our recommendation that physicians should consider performing abdominal imaging when HUS is being considered as a differential diagnosis.