Continuous renal replacement therapy in patients with HELLP syndrome

The HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count) is a well-recognized complication of severe preeclampsia and eclampsia, associated with poor maternal and fetal outcomes. There is still some controversy concerning the relationship between the HELLP syndrome and preeclampsia and eclampsia, and despite numerous publications the pathophysiology of the syndrome is not fully understood. In about 20% of patients, the classic signs of gestosis are absent; also, about 30% of the cases occur in the postpartum period, and these patients are at greater risk of pulmonary edema, adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and acute renal failure. The HELLP syndrome is mainly a systemic endothelial disease with associated activation of platelets and diffuse ischemic disorders. Similar to many other conditions (eg, sepsis, multiple trauma), it results in the generalized intravascular activation in inflammatory cells mediated by cytokines and leading to distinct organ injury. From this point of view, continuous renal replacement therapy (CRRT) can be used with success in these patients. Also, our observations, although limited, have shown that CRRT is able not only to heal the acute renal failure, but also to restore normal respiratory and liver function and heart contractility, making it difficult to separate the renal and nonrenal effects of continuous hemofiltration in this setting. Although more controlled trials are needed, we believe that CRRT should become a specific treatment for severe HELLP syndrome.