generally normal, distinguishing HUS from sepsis and disseminated intravascular coagulation A Coombs test will be negative A stool culture may help identify the causative organism but will not alter medical management of AKI The severity of the renal involvement in typical HUS varies widely and is not related to the degree of anemia present AKI may be mild and selflimited, associated with microscopic hematuria, mild proteinuria, and preserved renal function When renal microangiopathy is severe, fulminant oligoanuric renal failure may ensue and necessitate RRT Management Early IV hydration in the setting of known STEC enterocolitis is important Fluid administration, especially early in the course of illness when diarrhea may be present without signs of HUS, is associated with a decreased risk of requiring RRT, shorter hospital stays, and decreased risk of long-term sequelae Supportive care is the mainstay of therapy for typical HUS, once developed If intravascular volume depletion is present due to gastrointestinal losses and poor intake, fluid resuscitation with isotonic saline should be provided with repeated assessment of volume status in an effort to decrease the compounding effects of prerenal AKI Once the intravascular volume status has been restored, further fluid management should be guided by renal function and urine flow If oliguria is present, a trial of furosemide (0.5 to mg/kg/dose) may be provided to establish urine flow, although patients may require doses much larger than typical (up to mg/kg/dose) If oliguria persists, fluids should be provided at a rate to ensure adequate intravascular volume but avoid volume excess Both IV and oral intake should match the total of measurable output (urine and gastrointestinal losses) and insensible water losses, estimated at 300 to 400 mL/m2/day Frequent monitoring of fluid balance, weight, and vital signs is essential Hypertension may be managed with calcium channel blockers Anemia associated with typical HUS may be severe Packed red blood cell transfusions should be provided for symptomatic anemia or robust hemolysis with a hemoglobin