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Atypical hemolytic uremic syndrome associated with pregnancy: A case report

  • Authors:
    • Karen Paola Quintana Barragán
    • Hugo Alberto Roblero López
    • Luisa Fernanda Montemayor Burrola
    • América Villalobos Ulate
    • Ruben Alejandro Almela Mendoza
    • José Ángel Sánchez Ochoa
  • View Affiliations / Copyright

    Affiliations: Department of Internal Medicine, Hospital General Regional No. 1, Mexican Institute of Social Security, Chihuahua, Chihuahua 31000, Mexico
    Copyright: © Quintana Barragán et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 71
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    Published online on: September 23, 2025
       https://doi.org/10.3892/mi.2025.270
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Abstract

 Hemolytic uremic syndrome (HUS) is a microangiopathy characterized by hemolytic anemia, thrombocytopenia and acute renal failure. It affects 2 to 3 individuals per 100,000 in the population, with a higher prevalence among adult women. HUS is caused by the abnormal activation of the complement system, leading to endot2helial damage and the formation of microthrombi in renal capillaries, which determines the severity of the condition. Pregnancy may predispose individuals to HUS due to changes in the maternal immune system. The present study describes the case of a 29‑year‑old female patient who presented postpartum with purulent discharge, severe anemia (hemoglobin level, 4.6 g/dl), thrombocytopenia, acute kidney injury (creatinine level, 10.6 mg/dl) and elevated levels of lactate dehydrogenase (1,450 U/l). Despite antibiotic therapy and blood transfusions, she developed anuria, metabolic acidosis and acute pulmonary edema, requiring admission to the intensive care unit and mechanical ventilation. A peripheral blood smear revealed >10 schistocytes per high‑power field. A kidney biopsy confirmed HUS. Following stabilization with plasma infusions, corticosteroids and supportive care, she was discharged with intermittent hemodialysis and continues under nephrology follow‑up. On the whole, HUS is a rare condition that is increasingly recognized. The case presented herein highlights the rapid clinical progression of this condition, emphasizing the importance of diagnostic suspicion to reduce mortality and improve prognosis.
View Figures

Figure 1

Kidney biopsy findings consistent with
thrombotic microangiopathy (magnification, x40). (A) Glomerulus
with mesangiolysis, endothelial swelling and segmental duplication
of the glomerular basement membrane (H&E staining). (B)
Glomerular capillary loops illustrating mesangial expansion and
occlusion of capillary lumina by proliferating mesangial and
endothelial cells (PAS staining). (C) Extensive thrombotic
occlusion of glomerular capillaries and mesangial matrix expansion
(Masson’s trichrome staining). (D) Duplication of the glomerular
basement membrane and collapsed capillary tufts suggestive of
chronic microangiopathy (Jones silver staining). (E) Arteriolar
thrombosis and marked intimal thickening of interlobular arteries
(Masson’s trichrome staining). (F) Immunofluorescence showing
positive staining for fibrinogen (2+) within mesangium,
endothelium, and arterial thrombi. (G) Low-power panoramic view of
the renal cortex illustrating widespread vascular changes, tubular
atrophy (~10%), interstitial fibrosis, and vascular remodeling
consistent with arteriolonephrosclerosis and ‘onion-skin’
appearance of small arteries (Masson’s trichrome staining). These
histopathologic findings are characteristic of thrombotic
microangiopathy in both acute and chronic phases, with the absence
of immune complex deposition confirming a non-immune-mediated
etiology. Black arrows indicate endothelialitis and mesangiolysis.
Black triangles indicate capillary lumen obstruction by cell
proliferation. Black stars indicate fibrin thrombi in the
glomerulus. Black circle indicates glomerular basement membrane
duplication (membranoproliferative pattern). Black asterisk symbols
indicate arterial thrombus with subintimal fibrosis. Black rhombus
symbols indicate fibrinogen deposition (+2). Black squares indicate
arteriolonephrosclerosis with an ‘onion-skin’ pattern.

Figure 2

Clinical timeline and diagnostic
approach in a postpartum patient with atypical HUS. AKI, acute
kidney injury; CT, computed tomography HUS, hemolytic uremic
syndrome.
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Spandidos Publications style
Quintana Barragán KP, Roblero López HA, Montemayor Burrola LF, Ulate AV, Almela Mendoza RA and Sánchez Ochoa JÁ: Atypical hemolytic uremic syndrome associated with pregnancy: A case report. Med Int 5: 71, 2025.
APA
Quintana Barragán, K.P., Roblero López, H.A., Montemayor Burrola, L.F., Ulate, A.V., Almela Mendoza, R.A., & Sánchez Ochoa, J.Á. (2025). Atypical hemolytic uremic syndrome associated with pregnancy: A case report. Medicine International, 5, 71. https://doi.org/10.3892/mi.2025.270
MLA
Quintana Barragán, K. P., Roblero López, H. A., Montemayor Burrola, L. F., Ulate, A. V., Almela Mendoza, R. A., Sánchez Ochoa, J. Á."Atypical hemolytic uremic syndrome associated with pregnancy: A case report". Medicine International 5.6 (2025): 71.
Chicago
Quintana Barragán, K. P., Roblero López, H. A., Montemayor Burrola, L. F., Ulate, A. V., Almela Mendoza, R. A., Sánchez Ochoa, J. Á."Atypical hemolytic uremic syndrome associated with pregnancy: A case report". Medicine International 5, no. 6 (2025): 71. https://doi.org/10.3892/mi.2025.270
Copy and paste a formatted citation
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Spandidos Publications style
Quintana Barragán KP, Roblero López HA, Montemayor Burrola LF, Ulate AV, Almela Mendoza RA and Sánchez Ochoa JÁ: Atypical hemolytic uremic syndrome associated with pregnancy: A case report. Med Int 5: 71, 2025.
APA
Quintana Barragán, K.P., Roblero López, H.A., Montemayor Burrola, L.F., Ulate, A.V., Almela Mendoza, R.A., & Sánchez Ochoa, J.Á. (2025). Atypical hemolytic uremic syndrome associated with pregnancy: A case report. Medicine International, 5, 71. https://doi.org/10.3892/mi.2025.270
MLA
Quintana Barragán, K. P., Roblero López, H. A., Montemayor Burrola, L. F., Ulate, A. V., Almela Mendoza, R. A., Sánchez Ochoa, J. Á."Atypical hemolytic uremic syndrome associated with pregnancy: A case report". Medicine International 5.6 (2025): 71.
Chicago
Quintana Barragán, K. P., Roblero López, H. A., Montemayor Burrola, L. F., Ulate, A. V., Almela Mendoza, R. A., Sánchez Ochoa, J. Á."Atypical hemolytic uremic syndrome associated with pregnancy: A case report". Medicine International 5, no. 6 (2025): 71. https://doi.org/10.3892/mi.2025.270
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