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Post partum HUS

Aude Servais, Nadège Devillard, Véronique Frémeaux-Bacchi, Aurélie Hummel, Laurent Salomon, Cécile Contin-Bordes, Hélène Gomer, Christophe Legendre, Yahsou Delmas
BACKGROUND: A therapeutic strategy based on complement blockade by eculizumab is widely used to treat atypical haemolytic uraemic syndrome (aHUS). Recent data are available on the administration of eculizumab during pregnancy in patients treated for paroxysmal nocturnal haemoglobinuria but there are very few data for aHUS patients. METHODS: We analysed the use of eculizumab for the treatment of aHUS during five pregnancies in three patients and studied an additional pregnancy without eculizumab...
December 2016: Nephrology, Dialysis, Transplantation
Muaz Abudiab, Megan L Krause, Mary E Fidler, Karl A Nath, Suzanne M Norby
Thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and scleroderma renal crisis (SRC) all present with features of thrombotic microangiopathy. Distinguishing among these entities is critical, however, as treatments differ and may be mutually exclusive. We describe the case of a 25-year-old woman with an undefined mixed connective tissue disease who presented 6 weeks post-partum with fever, transient aphasia, thrombocytopenia, hemolytic anemia, and acute kidney injury eventually requiring initiation of hemodialysis...
October 2013: Clinical Nephrology
Alexandre Hertig, Christophe Ridel, Eric Rondeau
Hemolytic uremic syndrome (HUS) is related to a renal thrombotic microangiopathy, inducing hypertension and acute renal failure (ARF). Its pathogenesis involves an activation/lesion of microvascular endothelial cells, mainly in the renal vasculature, secondary to bacterial toxins, drugs, or autoantibodies. An overactivation of the complement alternate pathway secondary to a heterozygote deficiency of regulatory proteins (factor H, factor I or MCP) or to an activating mutation of factor B or C3 can also result in HUS...
July 2010: Néphrologie & Thérapeutique
B Moulin, A Hertig, E Rondeau
During normal pregnancy, renal blood flow and GFR increase gradually until they reach a peak of about 150% of their normal values by the end of the 1(st) trimester. This increase in GFR is secondary to the extra-cellular compartment expansion caused by a positive sodium balance of about 500-900 mmol which is in turn associated with a water retention amounting 6 to 8 liters. Blood pressure decreases during a normal pregnancy because of the decrease in peripheral vascular resistance. This drop in blood pressure is limited by the renin-angiotensin system...
April 2010: Annales Françaises D'anesthèsie et de Rèanimation
Mariarosaria Iannuzzi, Patrizia Siconolfi, Antonio D'Angelillo, Maria Capuano, Luigi Tufano, Michela Macri
HEMOLYTIC UREMIC SYNDROME POST-PARTUM: We describe a case of a 37-year-old woman admitted for severe renal failure to our hospital immediately after the delivery by caesarean section of twins. She had anuria, anemia, and moderate thrombocytopenia. A diagnosis of hemolytic-uremic syndrome was made. Plasma exchange was started, substitution was performed with fresh frozen plasma and eight consecutive plasmapheresis sessions were given. She received hydrocortisone and ACE inhibitors. After about fifteen days from the beginning of the illness, signs of active haemolysis disappeared and renal function was partially recovered...
February 2006: Transfusion and Apheresis Science
K Mahalati, R B Dawson, J O Collins, W R Bell, K R McCrae, J N Martin
The spectrum of complications with pre-eclampsia, which may include AFLP (acute fatty liver of pregnancy) as well as the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), is resolved by early delivery. However, the ravages of HUS/TTP (hemolytic uremic syndrome/thrombotic thrombocytopenic purpura) require therapy usually by plasma exchange. Overlap between these two groups of syndromes has occurred on rare occasions and usually requires the therapy of the predominant or more dangerous or threatening form...
1999: Journal of Clinical Apheresis
T Matsumae, S Takebayashi, S Naito
Twenty-eight adults who developed hemolytic-uremic syndrome (HUS) underwent a renal biopsy during the period from 1973 to 1993, and the specimens were analyzed both clinically and pathologically. The observed etiologic antecedents of HUS were infectious disease in 7 cases, medication, mainly due to cytotoxic drugs in 7 cases, post-partum in 7 cases, progressive systematic scleroderma in 1 case and unknown in 6 cases. Histologically, 17 cases were glomerular type, 3 cases were arterial type, 6 cases were mixed type and 2 cases demonstrated cortical necrosis...
March 1996: Clinical Nephrology
P Brandt, J Jespersen, G Gregersen
A 34-year-old woman with a family history of pregnancy-associated thrombotic disease developed pre-eclampsia in her 8th month of pregnancy. A severe haemolytic-uraemic syndrome (HUS) developed within 24 h after spontaneous delivery. Because the plasma antithrombin-III (AT-III) was only 15% of the normal concentration, an AT-III concentrate was given intravenously. When the normal level of plasma AT-III was reached, the clinical and biochemical signs of the syndrome disappeared. Renal function and biopsy were normal within 10 days...
1981: Nephron
H Leray, G Mourad, G du Cailar, C Mion
A 24-year-old woman presented a severe HUS followed 3 months later by a cardiac failure diagnosed echographically as a dilated cardiomyopathy. The patient was hemodialysed and successfully transplanted. Later course of dilated cardiomyopathy was favourable. Review of literature confirms the rare and severe nature of cardiac lesions occurring in the course of HUS. We suggest a related pathophysiology concerning these two entities.
1991: Néphrologie
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