PMC5438012_01
Clinical course of recurrent postpartum aHUS in a kidney allograft: response to eculizumab. The patient had a normal pregnancy until 26 weeks gestation when she was hospitalized for hypertension and proteinuria. After caesarian delivery for pre-eclampsia, the patient developed thrombocytopenia, hemolytic anemia, and AKI consistent with aHUS. Her hospital course and outpatient follow-up demonstrate successful response to eculizumab with relapse of disease once therapy was withdrawn and full recovery after therapy was reinstated. Her laboratory studies show return to baseline creatinine, resolution of thrombocytopenia, and cessation of hemolysis with normalization haptoglobin and lactate dehydrogenase with eculizumab. The dates of hospitalization were 09/12/2012 - 10/12/2012.
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Figure1
Within 48 hours of delivery she developed thrombocytopenia, hemolytic anemia, and AKI (Figure 1). Within 2 weeks of starting eculizumab therapy, there was complete successful resolution of thrombocytopenia, hemolysis, and renal failure with return to baseline kidney function (Figure 1). 
Light microscopy of kidney biopsy after withdrawal of eculizumab. a: Glomerulus with segmental membranoproliferative glomerulonephritis (MPGN) pattern and multiple large intravascular fibrin thrombi, vessel with thickened media with onion skinning pattern, findings are consistent with TMA. PAS stain 20x. b: A glomerulus with multiple intracapillary fibrin thrombi, MPGN pattern, basement membrane reduplication, and cellular interposition. Vessel showing thickened media. Jones BM stain 40x.
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Figure2
Kidney biopsy of the allograft at the time showed severe TMA without evidence of graft rejection (Figure 2).