Acute kidney injury requiring temporary hemodialysis due to HELLP syndrome: a case report

HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is a severe form of hypertensive disorder of pregnancy, causing multiorgan injury via thrombotic microangiopathy (TMA). Acute kidney injury (AKI) is a serious complication, but cases requiring dialysis are relatively uncommon. A 40-year-old, previously healthy primigravida developed acute hypertension, hemolysis, elevated liver enzymes, and thrombocytopenia on postpartum day 0, leading to a diagnosis of HELLP syndrome. Thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome (aHUS) were ruled out. She rapidly progressed to oliguric AKI with significant fluid overload, and her serum creatinine sharply increased from a baseline of 0.68 mg/dL (at 11 weeks gestation) to 1.66 mg/dL on admission, and further to 3.88 mg/dL by postpartum day 1. The patient was treated with intermittent hemodialysis for volume management and renal support, along with a continuous infusion of high-dose furosemide. She underwent five hemodialysis sessions over 12 days, after which her urine output increased and dialysis was discontinued. At 6 months after discharge, her serum creatinine had decreased to 1.6 mg/dL, indicating partial yet stable renal recovery corresponding to chronic kidney disease stage G3b. This case highlights that HELLP syndrome can cause severe AKI requiring temporary hemodialysis. With appropriate and timely supportive management, renal recovery sufficient for dialysis discontinuation can often be achieved. However, residual impairment may persist, emphasizing the importance of long-term nephrological follow-up after severe HELLP syndrome-associated AKI.