care, 80 percent of children survive. About 70 per-
cent of them recover fully with no residual health
problems. Among the other 30 percent renal fail-
ure progresses to END-STAGE RENAL DISEASE(ESRD),
often within months though sometimes over sev-
eral years, requiring long-term renal dialysis and
ultimately KIDNEY TRANSPLANTATION.
Risk Factors and Preventive Measures
Hemolytic uremic syndrome is a rare complication
of E. coliO157:H7 hemorrhagic enteritis, so any
child who acquires this infection incurs the risk
for the syndrome. There are no measures to pre-
vent hemolytic uremic syndrome as a complica-
tion of E. coli O157:H7 infection. Even with
prompt and aggressive medical care for the hem-
orrhagic enteritis, hemolytic uremic syndrome
remains a potential complication. The most effec-
tive preventive measures are precautions to pro-
tect against E. coli O157:H7 infection. Such
measures include
- wash hands with hot, soapy water before and
after handling meats - do not handle other foods when preparing
meats - use separate, nonporous surfaces and utensils
(not wooden) to prepare meats for cooking - wash food preparation surfaces and utensils
with hot soapy water immediately after prepar-
ing meats - thoroughly cook all meats to the recommended
temperatures for the kind of meat - thoroughly rinse all fruits and vegetables in
cold running water before eating or preparing
them
See also FOOD-BORNE ILLNESSES; GLOMERULUS.hepatorenal failure The progressive failure of the
KIDNEYSin people who have chronic LIVER FAILURE.
Doctors do not know what causes hepatorenal
failure, also called hepatorenal syndrome, to
develop though they do know the BLOODsupply to
the kidneys becomes suddenly and severely
restricted. Not enough blood flows through the
kidneys for the kidneys to filter waste byproducts
and toxins from the blood, and these substances
accumulate in the blood. Because the kidneys play
key roles in regulating BLOOD PRESSURE, HYPERTEN-
SION(elevated blood pressure) may also develop.
The primary symptom of hepatorenal failure is
diminished URINEproduction in a person who has
chronic liver failure. Symptoms of liver failure are
also often present and typically include ASCITES
(fluid retention in the abdominal cavity), JAUNDICE
(yellowish discoloration of the skin), and abnormal
bleeding. Blood and urine tests help evaluate liver
and kidney function, and diagnostic imaging proce-
dures such as abdominal ULTRASOUNDor COMPUTED
TOMOGRAPHY(CT) SCANdemonstrate the extent of
physical damage to the liver and the kidneys.
Treatment aims to improve both liver and kid-
ney functions. RENAL DIALYSISoften becomes neces-
sary. In some people the kidneys remain healthy
and return to full function when the underlying
liver disease improves, such as might occur with
LIVER TRANSPLANTATION. When liver disease is
severe, however, the progressive failure of the kid-
neys means the body loses nearly all of its ability
to remove toxins and the risk of death is very
high.
See also CIRRHOSIS; COAGULATION; ENCEPHALOPATHY;
LIVER DISEASE OF ALCOHOLISM.horseshoe kidney A random CONGENITAL ANOMALY
in which a band of tissue fuses the KIDNEYSat the
bottom, forming a shape resembling a horseshoe.
The tissue band, called an isthmus, may be fibrous
or the same tissue as the kidneys. In most people
who have this anomaly, both kidneys are fully
functional. However, the fusion distorts the nor-
mal structure of the kidneys, leading over time to
conditions such as HYDRONEPHROSIS(dilation of the
renal pelvis), NEPHROLITHIASIS(kidney stones), and
VESICOURETERAL REFLUX(backflow of URINEfrom the
BLADDERinto the ureters and kidneys). The BLOOD
vessels that supply the horseshoe kidney are often
intertwined and anomalous, providing abnormal
blood flow to the fused kidney that can affect its
functions. The horseshoe kidney also resides lower
in the abdominal cavity, placing it outside the pro-
tective enclosure of the rib cage. Horseshoe kidney
increases the risk for some types of primary RENAL
CANCER.
Two thirds of people who have horseshoe kid-
ney learn of the anomaly during diagnostic proce-horseshoe kidney 195