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Abstract: PUB344

Pregnancy-Associated Hemolytic Uremic Syndrome: Two Case Series From the University of Vermont Medical Center

Session Information

Category: Women's Health and Kidney Diseases

  • 2100 Women's Health and Kidney Diseases

Authors

  • Jensen, Colton, University of Vermont College of Medicine, Burlington, Vermont, United States
  • Geraci, Carolyn, University of Vermont Medical Center, Burlington, Vermont, United States
  • Onuigbo, Macaulay A., University of Vermont College of Medicine, Burlington, Vermont, United States
Introduction

Atypical hemolytic syndrome (aHUS) is rare, incidence 0.23/year/million; 10–20% occur around pregnancy - pregnancy-associated aHUS (PAaHUS). In a recent review, 47 of 50 (94%) occurred post-partum, with a median of post-partum day 2. We present 2 patients, seen in 2012 and in 2021, with some unusual features.

Case Description

Case I
A 37-yo female was diagnosed in late 2021 with PAaHUS following a preterm delivery by Cesarean section (Figure). She started hemodialysis for oliguric AKI, hyperkalemia and metabolic acidosis. Fiirst plasmapheresis was aborted due to anaphylactic reaction to plasma. She had Eculizumab for 4.5 months; switched to Revalizumab in February 2022. She came off hemodialysis after 23 days. Peak creatinine was 11.53 mg/dL, and the latest creatinine was 1.41 mg/dL in April 2022.

Case II
A 33-yo woman with 3 previous Cesarean sections, and who delivered her fourth child by Cesarean section 8 weeks previously, was diagnosed with PAaHUS, following transfer from an outside unit in late 2012, with weakness, anemia, schistocytes and oliguric acute kidney injury (Figure). She had 14 plasmaphereses alternating with hemodialysis. She came off hemodialysis after about 84 days. She had Eculizumab for nearly 7 years; switched to Revalizumab in December 2019. Peak creatinine was 7.7 mg/dL, and the latest creatinine was 1.64 mg/dL in May 2022.

Discussion

Although the renal and splenic arteries enhanced with contrast on CT in Case I, the kidneys did not. Whether this is typical of aHUS or if exposure to IV Ketorolac contributed to this picture is unknown. The nearly 60 days’ post-partum presentation for Case II is most unusual. Our patients have done well on continued Ravulizumab, with sustained AKI recovery, more so with Case II now spanning over 9 years.

Cases I and II