Shiga Toxin- Producing 
kidney failure, HUS, Shiga-toxin
HYPERHYDRATION, KIDNEY FAILURE, COMPLICATIONS

Shiga-toxin producing We do not know the best way to prevent HUS or to lessen damage to children’s kidneys. At this moment, your child does not have kidney failure or require dialysis. Two approaches are used to manage children at this stage. Many physicians recommend that children be monitored at home (and sometimes in hospital if children have severe symptoms) and wait for HUS to occur (or not as is the case for 80% of children), because there is no specific treatment that stops its progression. Some doctors recommend early hospitalization, even in well-appearing children, and administer a large volume of intravenous fluids based on the thought that this can prevent or lessen the severity of HUS.We are one of 26 hospitals participating in an international research study sponsored by the National Institutes of Health (NIH) seeking to compare the following two approaches to treating STEC-infections.
Traditional Approach: Children are treated either at home or in hospital based on the severity of symptoms and access to follow-up care and monitoring. The focus is on close monitoring and providing supportive care for HUS complications as early as possible.
Hyperhydration Approach: Children are treated in the hospital, even if they are feeling well. They receive lots of intravenous fluids to maximize kidney blood flow.Your child needs clinical care, but it is unknown which approach is best. Both approaches are currently in use, each has potential benefits and downsides, and no research has compared the two approaches.Our hospital has been assigned to the HYPERHYDRATION approach. We currently admit all STEC-infected children to the hospital, provide intravenous fluids, and closely monitor children until the doctors are confident that HUS is not going to develop. This usually requires 2 nights in hospital. If HUS does develop your child’s treatment will be determined and adjusted directly by their doctor. We hope this approach will prevent the development of HUS or lessen its severity should it occur.Please discuss any questions or concerns you may have with your child’s doctor before agreeing to the proposed treatment.
****Alternative language****Our hospital has been assigned to the TRADITIONAL approach. This approach promotes individualized decision making by your child’s doctor who will recommend if your child should be hospitalized or can be followed and managed at home. We believe this approach limits unnecessary hospitalizations, costs and complications from fluid administration. Please discuss any questions or concerns you may have with your child’s doctor before agreeing to the proposed treatment.
As with usual clinical care, the costs of treatment will be billed to insurance or is the responsibility of the patient. Both approaches reflect accepted clinical practice and the recommended monitoring and treatment are considered routine costs.