Is post-partum renal cortical necrosis in developing countries due to atypical hemolytic uremic syndrome?

Journal article

Introduction Pregnancy-related acute kidney injury is the most common cause of renal cortical necrosis (RCN). Atypical hemolytic uremic syndrome (aHUS) as a cause of RCN in pregnant/post-partum is under-evaluated. In the current manuscript, we describe a series of cases of pregnancy-related RCN. Materials and Methods All cases with AKI in the setting of pregnancy and post-partum state were included. Diagnosis of RCN was made by contrast-enhanced computerised tomography (non-enhancing renal cortex, enhancing medulla and no excretion of contrast medium) or on a renal biopsy. aHUS was diagnosed in the presence of microangiopathic hemolytic anaemia (thrombocytopenia, elevated lactate dehydrogenase with schistocytes on peripheral smear examination or low haptoglobin). Results A total of 21 (17.5%) patients presented with RCN during pregnancy, all in post-partum state. Twenty patients (95.2%) showed microangiopathic hemolytic anaemia consistent with HUS and 1 (4.8%) patient had biopsy-proven thrombotic microangiopathy. Low C3 or activation of alternate complement pathway was seen in 9 out of 15 patients in which it was done. At the end of 6 months, only 2 (9.5%) patients had partial recovery of renal functions, five (23.8%) patients died and 14 remained (66.7%) on hemodialysis. Conclusion The clinical and laboratory features are highly suggestive of aHUS in over three-fourths of cases with post-partum RCN. Investigations are needed to look for genetic abnormalities in the complement pathway.

Authors: Ramachandran, R; Nayak, S; Anakutti, H; Yadav, A; Nada, R

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Kidney International Reports
• Volume: 4
• Issue: 3
• Pages: 420-424
• Publication date: 2018-11-28
• Acceptance date: 2018-11-19
• DOI: 10.1016/j.ekir.2018.11.012
• ISSN: 2468-0249
• Keywords: renal cortical necrosis; HUS; AKI; pregnancy