Relación entre la hemólisis intravascular microangiopática y la disfunción renal en pacientes con preeclampsia.

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Title:	Relación entre la hemólisis intravascular microangiopática y la disfunción renal en pacientes con preeclampsia.
Authors:	Duarte-Mote, Jesús¹ hgnsjduarte@yahoo.com.mx, Jiménez A. J., Miguel², Lee-Eng C., Víctor³, Romero F., Socorro⁴, Espinosa L., Rogelio F.⁵, Jiménez A., Mari Carmen⁶, Sánchez R., Graciela⁷, Verduzco P., Julio⁸, Calvo C., Jesús⁸
Source:	Medicina Interna de México. jul/ago2013, Vol. 29 Issue 4, p351-355. 5p.
Subjects:	THROMBOTIC thrombocytopenic purpura, HEMOLYSIS & hemolysins, KIDNEY diseases, DISEASE complications, ENDOTHELIAL cells, PREECLAMPSIA, BLOOD platelet disorders
Abstract (English):	Background: Preeclampsia is today one of the most important causes of maternal morbidity and mortality. Renal dysfunction is one of the main complications in such patients and is a marker of severity of the process. The microangiopathic intravascular hemolysis is a manifestation of severe endothelial dysfunction and is related to perfusorious systemic problems in patients with preeclampsia. Microangiopathic intravascular hemolysis may be a marker associated with renal dysfunction. Objective: To determine if thrombotic intravascular hemolysis is a marker of bad evolution in patients with preeclampsia in the immediate postpartum. Material and method: An observational study included patients with preeclampsia admitted to the Obstetric Unit. Patients were classified into two groups: with renal dysfunction (serum creatinine levels ≥ 0.9 mg/dL) or normal renal function. Microangiopathic intravascular hemolysis was analyzed if patients presented positive peripheral blood smear, hemoglobinuria, elevated levels of lactic acid dehydrogenase and thrombocytopenia. Results: 81 patients with preeclampsia were included, at entering to Obstetric Unit 23 (28.3%) had renal dysfunction and 58 (71.7%) had normal renal function. At the 24 hours after partum 35 patients (43.2%) had renal dysfunction and 46 (56.8%) had normal renal function. Microangiopathic intravascular hemolysis was presented in six patients at entering and after 24 hours (7.4%). Al entering 17.3% and 3.4% of patients with renal dysfunction and normal renal function, respectively, presented microangiopathic intravascular hemolysis, OR 5.89 (95 CI 0.9-34.7) p = 0.031. At the 24 hours after partum 11.4% had renal dysfunction and 4.3% had normal renal function, OR 2.83 (95 CI 0.4-16.4) p = 0.2. In regard to peripheral blood smear, to the admission of the patients, 60.8% had renal dysfunction and 36.2% had normal renal function, OR 2.74 (CI 1.01-7.40) p = 0.0043. To 24 hours, 60% had renal dysfunction and 30.4% had normal renal function, OR 3.42 (95 CI 1.36-8.62) p = 0.008. Conclusion: Microangiopathic intravascular hemolysis has an inconsistent behavior in relation to renal dysfunction, in contrast to the presence of blurred cells on the peripheral blood smear. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Antecedentes: en la actualidad la preeclampsia es una de las causas de morbilidad y mortalidad materna más importantes. La disfunción renal es una de las principales complicaciones en las pacientes con preeclampsia y un marcador de gravedad del proceso. La hemólisis intravascular microangiopática es una manifestación de disfunción endotelial grave y se relaciona con los problemas de perfusión sistémicos en las pacientes con preeclampsia. La hemólisis intravascular microangiopática puede ser un marcador de disfunción renal. Objetivo: determinar si la hemólisis intravascular trombótica microangiopática es un marcador de mala evolución en el posparto inmediato en las pacientes con preeclampsia. Material y método: estudio observacional que incluyó a pacientes con preeclampsia ingresadas a la Unidad de Tococirugía. Las pacientes se dividieron en dos grupos: con disfunción renal (concentraciones séricas de creatinina ≥ 0.9 mg/dL) o con función renal normal. Se analizó la hemólisis intravascular microangiopática si las pacientes tenían frotis de sangre periférica positivo, hemoglobinuria, elevación de las concentraciones de deshidrogenasa láctica y trombocitopenia. Resultados: se incluyeron 81 pacientes con preeclampsia; al ingreso a la Unidad de Tococirugía, 23 (28.3%) tenían disfunción renal y 58 (71.7%) función renal normal. A las 24 horas 35 pacientes (43.2%) tenían disfunción renal y 46 (56.8%) función renal normal. La hemólisis intravascular microangiopática afectó a seis pacientes (7.4%) al ingreso y a las 24 horas del parto. Al ingreso 17.3 y 3.4% de las pacientes con disfunción renal y función renal normal, respectivamente, tuvieron hemólisis intravascular microangiopática (IC 95 0.9-34.7) p = 0.031. A las 24 horas, 11.4% tenía disfunción renal y 4.3% función renal normal, razón de momios de 2.83 (IC 95 0.4-16.4) p = 0.2. Con respecto al frotis de sangre periférica, al ingreso de las pacientes 60.8% tenía disfunción renal y 36.2% función renal normal, razón de momios de 2.74 (IC 95 1.01-7.40) p = 0.0043. A las 24 horas, 60% tenía disfunción renal y 30.4% función renal normal, razón de momios de 3.42 (IC 95 1.36-8.62) p = 0.008. Conclusiones: la hemólisis intravascular microangiopática se comporta de manera inconsistente en relación con la disfunción renal, a diferencia de la existencia de esquizocitos en el frotis de sangre periférica. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

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Abstract:	Background: Preeclampsia is today one of the most important causes of maternal morbidity and mortality. Renal dysfunction is one of the main complications in such patients and is a marker of severity of the process. The microangiopathic intravascular hemolysis is a manifestation of severe endothelial dysfunction and is related to perfusorious systemic problems in patients with preeclampsia. Microangiopathic intravascular hemolysis may be a marker associated with renal dysfunction. Objective: To determine if thrombotic intravascular hemolysis is a marker of bad evolution in patients with preeclampsia in the immediate postpartum. Material and method: An observational study included patients with preeclampsia admitted to the Obstetric Unit. Patients were classified into two groups: with renal dysfunction (serum creatinine levels ≥ 0.9 mg/dL) or normal renal function. Microangiopathic intravascular hemolysis was analyzed if patients presented positive peripheral blood smear, hemoglobinuria, elevated levels of lactic acid dehydrogenase and thrombocytopenia. Results: 81 patients with preeclampsia were included, at entering to Obstetric Unit 23 (28.3%) had renal dysfunction and 58 (71.7%) had normal renal function. At the 24 hours after partum 35 patients (43.2%) had renal dysfunction and 46 (56.8%) had normal renal function. Microangiopathic intravascular hemolysis was presented in six patients at entering and after 24 hours (7.4%). Al entering 17.3% and 3.4% of patients with renal dysfunction and normal renal function, respectively, presented microangiopathic intravascular hemolysis, OR 5.89 (95 CI 0.9-34.7) p = 0.031. At the 24 hours after partum 11.4% had renal dysfunction and 4.3% had normal renal function, OR 2.83 (95 CI 0.4-16.4) p = 0.2. In regard to peripheral blood smear, to the admission of the patients, 60.8% had renal dysfunction and 36.2% had normal renal function, OR 2.74 (CI 1.01-7.40) p = 0.0043. To 24 hours, 60% had renal dysfunction and 30.4% had normal renal function, OR 3.42 (95 CI 1.36-8.62) p = 0.008. Conclusion: Microangiopathic intravascular hemolysis has an inconsistent behavior in relation to renal dysfunction, in contrast to the presence of blurred cells on the peripheral blood smear. [ABSTRACT FROM AUTHOR]
ISSN:	01864866