[Hemolytic-uremic syndrome during oral contraception].

A hemolytic and uremic syndrome is described in a 41 year old woman on oral contraceptives for 18 years, only discontinued during the course of 4 normal pregnancies. A renal biopsy performed on the 20th day, after correction of the thrombopenia, confirms the typical aspect of advanced thrombotic microangiopathy. The usual etiological work-up is negative, but the search for steroidal anti-hormones antibodies by radioimmuno assay is positive. The evolution is favorable with hemodialysis, perfusion of fresh plasma during the sessions, calciparin, dipyridamol and anti-hypertensive drugs with, eight months later, a creatinin clearance of 45 ml/min and important persisting ischemic lesions in a new renal biopsy. The hemolytic and uremic syndrome following oral contraceptives remains rare (about thirty cases reported in the literature) and its prognosis remains severe despite a well adjusted treatment. Prevention includes the detection of risk patients and the search for steroidal anti-hormones antibodies could certainly play a role which remains to be evaluated.