Outcome of pregnancies with HELLP syndrome complicated by acute renal failure (1989-1999)

HELLP syndrome, a syndrome of hemolysis, elevated liver enzymes and low pla telets may occur in pregnancy with pre-eclampsia/eclampsia, and its a signi ficant complication is acute renal failure (ARF). The aim of study was to d etermine frequency and outcome of HELLP syndrome complicated by ARF. Thirty-nine patients with pregnancy-related ARF were treated between Jan 1, 1989 and Jan 1, 1999. In these patients, the most frequent causes were HEL LP syndrome (n = 14; 36%), postpartum hemorrhage (n = 10; 26%), pre-eclamps ia/eclampsia (n=6;15%) and abruptio placenta (n = 4,10%). Seven of the pati ents with HELLP syndrome had impairment of consciousness during hospitaliza tion. Of these patients, coma in 5, stupor in 1, confusion in 1 were diagno sed. Twelve of the patients with HELLP syndrome and 14 of the other patient s were treated by dialysis. Mann-Whitney U test and chi(2) test(corrected b y Yates and Fisher exact) were used for statistical analysis. Although serious clinical findings, with supportive treatment, 12 patients with HELLP syndrome and 21 other patients were fully recovered. One patient both with and without HELLP syndrome could not recovered due to diffus cor tical necrosis. Moreover, one patient with HELLP syndrome and 3 other patie nts were died. Mortality rate of the patients with HELLP syndrome was not f ound different from those of the other patients (p = 0.544). The causes of death were cerebral hemorrhage in patient with HELLP syndrome and dissemina ted intravascular coagulation (n = 1), cerebral emboli (n = 1), adult respi ratory distress syndrome (n = 1). Fetal death occured in 4 patients with HE LLP syndrome (28.5%) and 7 other patients (28%), and rates were similar (p > 0.5). Finally, HELLP syndrome was the most frequent cause leading to ARF in pregn ancy and their prognosis was not different from those of the other patients .