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Nephrol Dial Transplant. 2016 Dec;31(12):2122-2130. Epub 2016 Sep 1.

Atypical haemolytic uraemic syndrome and pregnancy: outcome with ongoing eculizumab.

Author information

1
Department of Nephrology and Transplantation, Hôpital Necker-Enfants Malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France.
2
Université Paris Descartes, Paris, France.
3
Department of Nephrology, CHU Besançon, Besançon, France.
4
Cordeliers Research Center, INSERM UMRS 872, 75006 Paris, France.
5
Department of Immunology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
6
Department of Obstetrics, Hôpital Necker-Enfants Malades, AP-HP, Paris, France.
7
Department of Immunology, CHU Bordeaux, CNRS-UMR 5164 Bordeaux University, Bordeaux, France.
8
Department of Obstetrics, CHU Bordeaux, Bordeaux, France.
9
Department of Nephrology Transplantation-Dialysis, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.

Abstract

BACKGROUND:

A therapeutic strategy based on complement blockade by eculizumab is widely used to treat atypical haemolytic uraemic syndrome (aHUS). Recent data are available on the administration of eculizumab during pregnancy in patients treated for paroxysmal nocturnal haemoglobinuria but there are very few data for aHUS patients.

METHODS:

We analysed the use of eculizumab for the treatment of aHUS during five pregnancies in three patients and studied an additional pregnancy without eculizumab. Obstetrical data and maternal and foetal complications during pregnancy, at delivery, and during the post-partum period were recorded.

RESULTS:

The mean age at pregnancy was 28.5 (range 25-33) years. The mean serum creatinine before pregnancy was 189 (range 130-300) µmol/L and the mean eGFR was 32 (range 18-45) mL/min/1.73 m2. One patient who stopped eculizumab 3 weeks after conception had a termination due to a relapse of HUS at 12 weeks of gestation (WG) during a first pregnancy and an intrauterine death at 24 WG despite continuous eculizumab treatment during a second pregnancy. In the other four pregnancies, treatment stabilized clinical and laboratory markers until 29-34 WG, but did not prevent hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome in one patient or pre-eclampsia in two other patients. All babies were born preterm and two presented with growth retardation. The mean body weight was 1632.5 (range 1070-2500) g. The dose of eculizumab had to be increased during all pregnancies due to incomplete complement blockade.

CONCLUSIONS:

Eculizumab therapy during pregnancy displayed no overt safety issues but did not appear to prevent HELLP syndrome or pre-eclampsia in these high-risk chronic kidney disease patients.

KEYWORDS:

HELLP syndrome; atypical haemolytic uraemic syndrome; eculizumab; pre-eclampsia; pregnancy

PMID:
27587606
DOI:
10.1093/ndt/gfw314
[Indexed for MEDLINE]

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