A Clinical Analysis Of59Cases Of The Renal Impairment Associated With HELLP Syndrome

Objective Summarize the clinical characteristics, treatment and prognosis of kidneydamage associated with HELLP syndrome in Suzhou Municipal Hospital and our hospital,in order to improve clinical understanding of HELLP syndrome.Methods Analyze the clinical characteristics, treatment and prognosis of59cases ofhospitalized patients with HELLP syndrome in Suzhou Municipal Hospital and ourhospital since January2010to December2013laboratory test results.Results There ages were ranging between16to47years old, mean age was (29.8±5.8) years. Postpartum onset were10cases,49cases were prenatal onset. prenatal onsetpatients are diagnosed in gestational age24+1～39+3weeks, postpartum onset all within48hours. In this group, common clinical symptoms were hypertension(100%), lowerextremity edema(81.4%), dizziness or headache (37.3%), gross hematuria(13.6%),oliguria(10.2%), proteinuria(100%), elevated serum creatinine(64.4%).The treatment of HELLP syndrome with renal impairment included spasmolysis,antihypertension, glucocorticoids and other general treatment of HELLP syndrome, as wellas plasma treatment and renal replacement therapy. In this study, we used magnesiumsulfate (88.1%), nifedipine (72.9%), amlodipine (18.6%), felodipine (10.2%), nicardipine(8.5%), labetalol (84.8%), betaloc (6.8%), nitroglycerin (8.5%), nitrate, sodium (1.7%),irbesartan (6.8%), valsartan (1.7%) for antihypertension,55cases (93.2%) patients’ bloodpressure were up to standard. All patients were using glucocorticoid therapy, includingmethylprednisolone, dexamethasone, prednisone.9Dexamethasone for antenatal was10~20mg mg intravenous,1times a day, until the delivery; Postpartum use1~5days.Methylprednisolone wasused with40mg intravenous, daily1time to delivery, postpartum1~2times a day, use1~5days, then reduced to half the amount, using1~3days.Dexamethasone was10to30mg intravenous, use1~3days in patients with postpartumdisease; methylprednisolone was40mg intravenous,1~2times a day, use1~5days, forhalf the amount, use1~3days. Then2patients instead of oral prednisone, gradually reduced.4.9%of patients using the plasma treatment,2serious patients underwent plasmareplacement treatment. In38cases of patients with elevated serum creatinine, six patientsundertook CVVH or HD treatment.30.5%patients’ urine protein was negative,73%renalfunction recovered, only2cases (5.3%) developed into CRF.Conclusion1. HELLP syndrome is a serious complication of pregnancy, mostpatients were prenatal onset, postpartum onset within48hours postpartum.2. The clinical manifestations of the renal impairment associated with HELLPsyndrome were proteinuria, hypertension, lower extremity edema, dizziness, headache,hematuria, oliguria and renal function decline.3. Early diagnosis and prompt treatment with plasma and glucocorticoid mayaccelerate remission, improve long-term prognosis of patients with renal impairment.