Clinical outcome in three patients with postpartum hemolytic uremic syndrome treated with frequent plasma exchange.

This study reviewed 3 cases of postpartum hemolytic uremic syndrome (HUS) at our hospital over a 3 year period. The 3 patients had clinical and laboratory abnormalities similar to those of 12 patients with other causes of thrombotic microangiopathy presenting during the same time span. Both groups were treated with 4-7 plasma exchange treatments/week and prednisone, 60 mg/day or its intravenous equivalent, until remission. The postpartum HUS patients had a more complicated, prolonged course; 3 of 3 required dialysis compared to 4 of 12 in the nonpostpartum group (p < 0.05), and they required more plasma exchange treatments (49 +/- 17 vs. 10 +/- 8, p = 0.0001) and a longer duration of therapy (70 +/- 31 vs. 19 +/- 17 days, p < 0.01) before remission. All postpartum HUS patients discontinued dialysis and survived whereas 4/12 nonpostpartum patients died before attaining remission. Compared to other variants of thrombotic microangiopathy, postpartum HUS requires a longer duration of therapy, but with aggressive therapy, renal and overall prognoses may be better.