Renal dysfunction and current biomarkers of renal damage in HELLP syndrome and obstetric atypical hemolytic uremic syndrome

Objective: to evaluate the changes in biomarkers of acute kidney injury (AKI) in obstetric patients with atypical hemolytic uremic syndrome (aHUS) and HELLP syndrome. Materials and methods: the study included 6 patients with HELLP syndrome and 3 patients with aHUS. All patients were assessed for the presence of "classic" signs of AKI - AKI was diagnosed according to the presence of at least one of the criteria listed by Prakash J. et al.: (1) sudden increase in serum creatinine >90 µmol/L, (2) oliguria/anuria, and (3) need for dialysis. In addition to routine clinical and laboratory examinations, all patients were examined for levels of retinol-binding protein, α1-microglobulin, cystatin C, podocalyxin, NGAL, and kidney injury molecule-1 (KIM-1) in urine. Results: AKI was diagnosed by standard methods in all patients with aHUS and in half of patients with HELLP syndrome, while biomarkers were elevated in absolutely all patients. The minimal number of simultaneously elevated biomarkers was three. All patients had an increase in the level of α1-microglobulin and retinol-binding protein, 67% of patients had an increase in the level of cystatin C, 44% of KIM-1, and 33% of NGAL, which indicates a significant damage to the renal tubular apparatus. The marked increase in the level of podocalyxin in all patients confirms the presence of glomerulopathy in all cases of TMA, even in the absence of "classic" symptoms of AKI. Conclusions: signs of AKI are observed in all patients with signs of TMA, however, in half of patients with HELLP syndrome, kidney damage was subclinical. An increase in the level of various AKI markers characterizes complex damage to various parts of the nephron, including the distal tubules. We suggest that the use of urinary biomarkers may be useful for early diagnosis and timely treatment of AKI.

беременность, атипичный гемолитико-уремический синдром, HELLP-синдром, острое повреждение почек, ретинол-связывающий белок, α1-микроглобулин, цистатин С, подокаликсин, NGAL, молекула повреждения почек-1 (KIM-1), pregnancy, atypical hemolytic uremic syndrome, HELLP-syndrome, acute kidney injury, retinol-binding protein, α1-microglobulin, cystatin C, podocalyxin, NGAL, kidney injury molecule-1 (KIM-1)

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