Nephrology Dialysis Transplantation an Unusual Complication of Pregnancy
نویسنده
چکیده
A 31-year-old primigravida, previously fit and well, was swelling of her hands and feet 3 weeks later. Renal noted by her health visitor to be pale 6 weeks after a function was impaired (Cr 142), urinalysis showed only normal full-term pregnancy. A routine full blood count a trace of protein and +1 blood and microscopy showed and film showed evidence of a microangiopathic haemoan inactive urinary sediment. Blood pressure was elevlytic anaemia (Hb 9 g/dl ) and thrombocytopenia (PLT ated (160/110) but fundoscopy was normal. 82×109/l ) but a normal coagulation screen. On further Autoimmune serology (antinuclear antibodies (ANA) questioning, she admitted to generalized aching and and anticardiolipin antibodies) were negative and comlethargy 1 week after delivery and had noted increasing plement levels (C3, C4) were normal. A diagnosis of tiredness, breathlessness, proximal muscle weakness and idiopathic post-partum haemolytic uraemic syndrome (HUS) was made and she was started on antihypertensives and aspirin. Because of persisting thrombocytopenia, haemolysis and deteriorating renal function, plasma infusion followed by plasma exchange with fresh frozen plasma (FFP) was commenced from day 9 of presentation and a renal biopsy (Figure 1) performed on day 22. Despite daily plasma exchange with FFP and cryosupernatant, she became dialysis dependent by day 24. Her course was complicated by refractory hypertension, profound ischaemic retinopathy (Figure 2), continuing haemolysis and severe left ventricular failure, the latter requiring treatment with daily volume removal, digoxin and captopril. Somewhat unexpec-
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تاریخ انتشار 1999