A RARE CASE OF OBSTETRIC ACUTE KIDNEY INJURY
Abstract
Pregnancy balances the nature
by modulating innate immune system,
coagulation system, and angiogenesis
to deliver a new life. Tilting the balance
towards other side paves the way
for newer pathophysiology, one such is
t h r o m b o t i c m i c r o a n g i o p a t h y
(TMA).Thrombotic microangiopathies
(TMA) are the disorders that arise due to
diffuse endothelial damage. They complicate
pregnancy with high mortality and
morbidity. They predominantly manifest
either as thrombotic thrombocytopenic
purpura (TTP) or hemolytic uremic syndrome
(HUS). It is difficult to distinguish
TMA from severe preeclampsia, HELLP
(hemolysis, elevated liver enzymes and
low platelets) syndrome and acute fatty
liver of pregnancy. Diagnosis of postpartum
TMA needs a high index of suspicion
because early initiation of plasmapheresis
has reduced the mortality rate from
90 to 20.We report a 25 year old lady
who presented with postpartum acute
kidney injury, whose biopsy revealed
TMA for which prompt initiation of plasmapheresis
helped in renal recovery.
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