Development of atypical hemolytic uremic syndrome after gynecologic surgery: clinical presentations, diagnosis, and treatment
Objective. To carry out a systematic analysis of the data available in present-day literature on the types of thrombotic microangiopathy, the trigger for which may become gynecologic surgery.Kirsanova T.V., Vinogradova M.A., Shmakov R.G.
Material and methods. The paper describes an extremely rare case of atypical hemolytic uremic syndrome (aHUS) in gynecological practice, which has an unusual clinical picture including deep vein thrombosis with pulmonary embolism (PE) in addition to acute renal failure.
Results. The paper depicts a differential diagnostic search between different types of thrombotic microangiopathy, which could be induced by gynecologic surgery. It considers all the triggers or complement-activating conditions, which result in aHUS, identifies the stages of diagnosis, and views the complexity of treatment, the choice of therapeutic approaches, and a quick response to targeted therapy with eculizumab.
Conclusion. The given clinical case showed a manifestation of aHUS with deep vein thrombosis and PE after diagnostic uterine curettage in the patient. Pathogenetic treatment initiated on day 7 after the onset of aHUS could rapidly achieve not only a hematologic response, but also restore the function of the kidneys and other affected organs.
Keywords
thrombotic microangiopathy
atypical hemolytic uremic syndrome
deep vein thrombosis
catastrophic antiphospholipid syndrome
Supplementary Materials
- Fig. 1. Dynamics of laboratory parameters of patient A.
- Fig. 2. Arterio-venous shunt at the level of the interlobar arteries, impoverishment of the cortical blood flow according to the ultrasound dopplerography data of the renal arteries
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Received 09.03.2017
Accepted 28.04.2017
About the Authors
Kirsanova T.V., PhD, Senior Researcher of the Therapeutic Department, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.117997, Russia, Moscow, Ac. Oparina str. 4
Vinogradova M.A., PhD, Head of the Division of Hematology and Clinical Reproductive Hemostasis, Research Center of Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4
Shmakov R.G., Doctor of Medicine, Head Physician, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954381183. Е-mail: r_shmakov@oparina4.ru
For citations: Kirsanova T.V., Vinogradova M.A., Shmakov R.G. Development of atypical hemolytic uremic syndrome after gynecologic surgery: clinical presentations, diagnosis, and treatment. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (1): 154-60. (in Russian)
https://dx.doi.org/10.18565/aig.2018.1.154-160
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