A case of HELLP syndrome that required hemodialysis due to sustained acute kidney dysfunction after delivery

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  • Kohata Nao
    Department of Internal Medicine, School of Medicine, Keio University
  • Wakino Shu
    Department of Internal Medicine, School of Medicine, Keio University
  • Tokuyama Hirobumi
    Department of Internal Medicine, School of Medicine, Keio University
  • Hayashi Koichi
    Department of Internal Medicine, School of Medicine, Keio University
  • Hayashi Matsuhiko
    Apheresis and Dialysis Center, School of Medicine, Keio University
  • Ochiai Daigo
    Department of Obstetrics and Gynecology, School of Medicine, Keio University
  • Sato Suguru
    Department of Obstetrics and Gynecology, School of Medicine, Keio University
  • Nakamura Kanako
    Department of Obstetrics and Gynecology, School of Medicine, Keio University
  • Senba Hiroshi
    Department of Obstetrics and Gynecology, School of Medicine, Keio University
  • Tanaka Mamoru
    Department of Obstetrics and Gynecology, School of Medicine, Keio University
  • Itoh Hiroshi
    Department of Internal Medicine, School of Medicine, Keio University

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Other Title
  • 出産後腎障害が遷延し, 血液透析を要したHELLP症候群の1例
  • 症例報告 出産後腎障害が遷延し,血液透析を要したHELLP症候群の1例
  • ショウレイ ホウコク シュッサン ゴジンショウガイ ガ センエン シ,ケツエキ トウセキ オ ヨウシタ HELLP ショウコウグン ノ 1レイ

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Abstract

<p>A 33-year-old pregnant female presented with mild proteinuria and hypertension at 29 weeks’ gestation. She was treated with oral anti-hypertensives, which failed to control blood pressure. Fetal growth restriction was observed, and the patient was hospitalized at 30 weeks’ gestation. On the same day, her blood pressure rapidly increased, and a headache, upper-right abdominal pain, vomiting, and blurred vision appeared. Blood tests detected elevated liver enzyme levels, thrombocytopenia, and hemolysis. The patient was diagnosed with HELLP syndrome, and an emergency caesarian section was performed. After delivery, she suffered from a consciousness disturbance, and her cranial magnetic resonance imaging findings were suggestive of posterior reversible encephalopathy syndrome. Her liver enzyme levels increased markedly, but peaked shortly after, and her thrombocytopenia and hemolysis also gradually improved. However, a sustained reduction in urinary volume and kidney dysfunction were evident after delivery. Hemodialysis was initiated, and fresh frozen plasma was administered. After a week of dialysis therapy, she gradually recovered, and the hemodialysis was eventually terminated. HELLP syndrome is a type of thrombotic microangiopathy that occurs during gestation. Prolonged kidney dysfunction is rare in patients with HELLP syndrome and usually disappears quickly after the termination of gestation. In this case, progressive and prolonged kidney damage was seen after delivery.</p>

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