Cyclosporine-associated post-partum haemolytic uraemic syndrome in a renaltransplant patient: lack of response to plasmapheresis but remission afterintravenous immunoglobulin G

We present the case of a young woman who developed severe post-partum (cycl osporine-associated) haemolytic uraemic syndrome (HUS) 6 years after a livi ng related donor kidney transplant. Her pregnancy had become complicated wi th preeclampsia (hypertension and nephrotic syndrome) and progressive renal insufficiency extending for 1 month after delivery, and there was evidence of cyclosporine vasculopathy on a kidney biopsy. Despite six daily treatme nts with plasmapheresis and fresh-frozen plasma replacement, her HUS progre ssively deteriorated, culminating in severe pulmonary haemorrhage. At this point, treatment with i.v. infusion of immunoglobulin G was initiated, whic h resulted in resolution of HUS. Moreover, at the time of diagnosis of HUS the patient was taken off cyclosporine and maintained on mycophenolate mofe til and prednisone.