[Acute renal insufficiency in HELLP syndrome]

We have studied patients with acute renal failure (ARF) + HELLP Syndrome admitted to the Adult Intensive Care Unit (AICU) between 1995 and 1996. ARF was considered when serum creatinine was greater than 1.2 mg/ml for at least 48 h. During this period, there were 173 patients with HELLP and 34 with ARF (20%). Most of cases maintained high renal output (more than 800 ml/24 h). We observed that correct fluid management restored oliguric ARF patients to adequate renal output with a better prognosis. Dialysis was necessary in 10 cases, peritoneal dialysis was preferred in our environment, because of its low morbidity. In three cases anuria (output less than 100 ml/24 h) was present and resistant to treatment with intravenous fluids, furosemide and/or dopamine and finally required early dialysis. The most significant morbidity was associated with HELLP. It was present in 60% of cases and was more frequent in those who developed oligoanuria. Hypovolemia increased the risk of ARF. Maternal mortality was of 12% (N = 4), secondary to hemorrhagic stroke and ARDS.