EARLY GESTATIONAL HEMOLYTIC-UREMIC SYNDROME - CASE-REPORT AND REVIEW OF LITERATURE

Hemolytic uremic syndrome (HUS) is a rare condition which most frequen tly follows gastrointestinal or respiratory infection episodes in youn g children, but it can also occur in other settings such as the postpa rtum period and during use of drugs such as oral contraconceptives, im munosuppressors, and antineoplastics. In early pregnancy, however its frequency is thought to be very low. The authors report a case of a 30 -year-old woman who developed HUS early in her first pregnancy. She ha d persistent aqueous diarrhea from the beginning of the pregnancy. Ar the 21st week she developed hypertension which in 2 weeks was followed by seizures, oliguria, and acute pulmonary edema despite intensive me dical efforts to control her blood pressure. Surgical intervention for fetal delivery was performed The patient was initially kept on contin uous hemodialysis (CVVHD) followed by an alternate-day conventional he modialysis schedule. A peripheral blood analysis showed a microangiopa thic hemolytic anemia with thrombocytopenia; blood coagulation tests w ere completely normal. A brain CT scan and an abdominal MRI showed no major abnormalities. HUS was confirmed by a percutaneal kidney biopsy, performed at the 21st day of anuria. Techniques for identification of verotoxin-producing E. coli were not available. Renal function did no t recover and the patient has been undergoing regular maintenance hemo dialysis for a year.