Acute Renal Failure Postpartum: A Complex Diagnosis?

Abstract

The differential diagnosis of postpartum acute renal failure associated with microangiopathic hemolytic anemia and thrombocytopenia includes, among others: severe preeclampsia, eclampsia, HELLP syndrome (hemolysis, elevated liver enzyme, low platelet), acute fatty liver of pregnancy (AFLP), thrombotic thrombocytopenic purpura/hemolytic uremic syndrome associated with pregnancy (TTP/aHUS), acute onset or flare of SLE in pregnancy and catastrophic antiphospholipid syndrome (CAPS). These conditions are potentially life threatening due to the presence of multi-organ dysfunction. The occurrence of an hypercoagulable state with decreasing concentration of ADAMTS 13 in pregnancy and in postpartum increases the risk of developing thrombotic thrombocytopenic purpura (TTP). Yet there is a considerable overlap of the clinical and laboratory tools detecting these conditions, therefore the diagnosis may be problematic even for experienced clinicians. However, it is important to establish an accurate diagnosis as the management and complications of these syndromes may be different. This case highlights the complexity of the differential diagnosis in case of microangiopathic hemolytic anemia and thrombocytopenia associated with pregnancy and the role of plasma exchange in their management.