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Hemolytic Uremic Syndrome in Pregnancy and Post-Partum
Lookup NU author(s)
Professor David Kavanagh
Dr Edwin Wong
Dr Vicky Brocklebank
Bruel A, Kavanagh D, Noris M, Delmas Y, Wong E, Bresin E, Provôt F, Brocklebank V, Mele C, Remuzzi G, Loirat C, Frémeaux-Bacchi V, Fakhouri F
Clinical Journal of the American Society of Nephrology
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Pregnancy is associated with various forms of thrombotic microangiopathy, including the hemolytic uremic syndrome. A previous small French study suggested that pregnancy-associated hemolytic uremic syndrome was to be included in the spectrum of atypical HUS linked to complement alternative pathway dysregulation.
Design, setting, participants and measurements:
We sought to retrospectively analyze the presentation, outcome, and frequency of complement alternative pathway genes variants in a larger international (France, United Kingdom, Italy) cohort of patients with pregnancy-associated hemolytic uremic syndrome.
Eighty-seven patients with pregnancy-associated hemolytic uremic syndrome were included. Hemolytic uremic syndrome occurred mainly during the first pregnancy (58%) and in the post-partum period (76%). At diagnosis, 56 (71%) patients required dialysis. Fifty-six (78%) patients underwent plasma exchanges, 21 (41%) received plasma infusions and 4 (5%) received eculizumab. During follow-up (mean duration of 7.2 years), 41 (53%) patients reached end-stage renal disease, 15 (19%) had chronic kidney disease and 18 (28%) patients experienced hemolytic uremic syndrome relapse. Twenty four patients (27%) received a renal transplant and a recurrence of hemolytic uremic syndrome occurred in 13 (54%) cases. Variants in complement genes were detected in 49 (56%) patients, mainly in the CFH (30%) and CFI genes (9%).
Pregnancy-associated hemolytic uremic syndrome and atypical hemolytic uremic syndrome non-related to pregnancy have the same severity at onset and during follow-up and the same frequency of complement gene variants.
American Society of Nephrology
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