Clinical outcome in three patients with postpartum hemolytic uremic syndrome treated with frequent plasma exchange.
This study reviewed 3 cases of postpartum hemolytic uremic syndrome (HUS) at our hospital over a 3 year period. The 3 patients had clinical and laboratory abnormalities similar to those of 12 patients with other causes of thrombotic microangiopathy presenting during the same time span. Both groups were treated with 4-7 plasma exchange treatments/week and prednisone, 60 mg/day or its intravenous equivalent, until remission. The postpartum HUS patients had a more complicated, prolonged course; 3 of 3 required dialysis compared to 4 of 12 in the nonpostpartum group (p < 0.05), and they required more plasma exchange treatments (49 +/- 17 vs. 10 +/- 8, p = 0.0001) and a longer duration of therapy (70 +/- 31 vs. 19 +/- 17 days, p < 0.01) before remission. All postpartum HUS patients discontinued dialysis and survived whereas 4/12 nonpostpartum patients died before attaining remission. Compared to other variants of thrombotic microangiopathy, postpartum HUS requires a longer duration of therapy, but with aggressive therapy, renal and overall prognoses may be better.
Shemin
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Department of Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence 02903, USA.
Dworkin
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LD
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods*; D011241:Prednisone / Q000627:therapeutic use; D011644:Puerperal Disorders / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012074:Remission Induction; D006435:Renal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D011241:Prednisone