A RARE CASE OF OBSTETRIC ACUTE KIDNEY INJURY

Pregnancy balances the nature by modulating innate immune system, coagulation system, and angiogenesis to deliver a new life. Tilting the balance towards other side paves the way for newer pathophysiology, one such is t h r o m b o t i c m i c r o a n g i o p a t h y (TMA).Thrombotic microangiopathies (TMA) are the disorders that arise due to diffuse endothelial damage. They complicate pregnancy with high mortality and morbidity. They predominantly manifest either as thrombotic thrombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS). It is difficult to distinguish TMA from severe preeclampsia, HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome and acute fatty liver of pregnancy. Diagnosis of postpartum TMA needs a high index of suspicion because early initiation of plasmapheresis has reduced the mortality rate from 90 to 20.We report a 25 year old lady who presented with postpartum acute kidney injury, whose biopsy revealed TMA for which prompt initiation of plasmapheresis helped in renal recovery