Nursing Care in Postpartum Atypical Hemolytic Uremic Syndrome: A Case Report

Pregnancy-associated atypical hemolytic uremic syndrome (P-aHUS) is a systemic disease associated with high morbidity and mortality rates, caused by dysregulation of the alternative complement pathway, leading to uncontrolled complement activation resulting in thrombotic microangiopathy. In this case it’s reported patient care management of a P-aHUS patient which developed in postpartum period with renal failure, anasarca edema, hypertension and important laboratory signs of the syndrome. Patient was effectively treated by hemodialysis and eculizumab therapy, which controls complement activation and discharged without signs of hemolysis. The patient was discharged to home from the hospital after 42 days. At follow-up 2 weeks after discharge, all signs and symptoms of renal failure had resolved. The patient has not had any inpatient readmissions to the hospital to date. There are no case report in P-aHUS nursing care. Discussion of this case contributes the literature describing nursing interventions associated with caring for patients with P-aHUS.

Keywords:

postpartum uremic hemolytic syndrome, nursing,

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1. Dashe JS, Ramin SM, Cunningham FG. The long-term consequences of thrombotic microangiopathy (thrombotic thrombocytopenic purpura and hemolytic uremic syndrome) in pregnancy. Obstet Gynecol 1998; 5: 662-668.
2. Furlan M, Robles R, Galbusera M, Remuzzi G, Kyrle PA, Brenner B, Krause M, Scharrer I, Aumann V, Mittler U, Solenthaler M, Lammle B. von Willebrand factor-cleaving protease in thrombotic thrombocytopenic purpura and the hemolytic-uremic syndrome. N Engl J Med 1998; 339:1578-1584.
3. Levy GG, Nichols WC, Lian EC. Mutations in a member of the ADAMTS gene family cause thrombotic thrombocytopenic purpura. Nature 2001; 6855:488-494.
4. Robson JS, Martin AM, Ruckley VA, Macdonald MK. Irreversible post-partum renal failure. A new syndrome. QJ Med 1968; 147:423-435.
5. Ardissino G, Wally OM, Baffero GM, Rigotti A, Cugno M. Eculizumab for atypical hemolytic uremic syndrome in pregnancy. Obstet Gynecol 2013; 2:487-489.
6. Ackley BJ, Ladwig GB. Nursing diagnosis handbook: an evidence-based guide to planning care. 10th ed. Maryland Heights, Missouri: Mosby Elsevier; 2014.
7. Fakhouri F, Roumenina L, Provot F, Sallee M, Caillard S, Couzi L, Essig M, Ribes D, Dragon Durey MA, Bridoux F, Rondeau E, Fremeaux-Bacchi V. Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations. J Am Soc Nephrol 2010; 5:859-867.