POSTPARTUM RENAL CORTICAL NECROSIS IS ASSOCIATED WITH DISTINCT THROMBOTIC MICROANGIOPATHY SYNDROME

Introduction:

Postpartum renal cortical necrosis is associated with poor renal outcomes. Its clinical-etiological spectrum and mechanisms are not yet fully elucidated. This study aims to explore the clinical profiles contributing to postpartum renal cortical necrosis and its prognostic factors.

Methods:

It was a retrospective cohort study spanning 2 years, from January 2022 to December 2023. The study collected clinico-laboratory and renal biopsy data from postpartum women who suffered acute kidney injury requiring dialysis. Out of 88 patients, 25 were diagnosed with renal cortical necrosis based on renal biopsy (n=23) and contrast-enhanced computed tomography (n=2). The study also evaluated the renal outcomes at the three-month follow-up.

Results:

Most patients (92%) were referred. Etiological factors observed were puerperal sepsis (n=9), atypical hemolytic uremic syndrome (n=7), placental abruption (n=7), postpartum hemorrhage (n=7), lupus nephritis (n=2), and thrombotic thrombocytopenic purpura (n=1). All 25 patients exhibited thrombotic microangiopathy features on biopsy or hematological findings and variable degrees of transaminitis.

(Fig.1)                                              

Most of the hematological parameters except serum creatinine improved significantly during the follow-up. Four out of the 25 patients experienced partial renal recovery, while 21 showed no renal recovery. The median levels of LDH and D-dimer during follow-up were significantly associated with poor renal outcome (p= 0.008 and p= 0.011, respectively). All 25 patients showed late "pseudo-improvement" in renal function with increased urine output but no actual kidney function improvement.        

(Fig.2)                                              

Conclusions:

Postpartum renal cortical necrosis is associated with thrombotic microangiopathy syndrome, characterized by a distinctive etiological spectrum, variable degree of transaminitis, and late pseudo-improvement in renal function. Moreover, higher follow-up LDH and D-dimer levels were associated with poor renal outcomes.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.