Comparative efficacy of the original and biosimilar eculizumab in the treatment of obstetric atypical hemolytic-uremic syndrome

Introduction. All thrombotic microangiopathy (TMA) variants in obstetric practice have a diverse clinical presentation and can manifest as various system and organ damage, which often makes it difficult or interfere with the diagnostic assessment, thus slowing down initiation of the necessary therapy.Aim. To study the clinical presentations of various TMA variants in obstetric practice.Materials and methods. A total of 313 pregnant women were enrolled in the study, of which atypical hemolytic uremic syndrome (aHUS) was diagnosed in 71 women, “HELLP syndrome” in 124 women, and “PE” with varied severity in 70 women. A group of patients with more rare causes of TMA was also identified: TTP and sepsis in 13 patients, and 35 patients without signs of TMA were included in the control group. We assessed and compared the main clinical, laboratory and instrumental findings.Results. The study identified damage to various systems and organs in various TMA types in obstetric practice. The damage to kidneys, liver, nervous system, visual organs was observed in patients with aHUS, HELLP syndrome, TTP, septic TMA and PE, while the damage to skin, cardiovascular system and lungs was detected in patients from all groups except for PE. Small and large vessel thrombotic complications were detected in patients from the former three groups. The patients with aHUS showed the maximum multisystemic presentation severity.Conclusions. The thrombotic microangiopathy in obstetrics is generalized in nature, and various symptoms of organ dysfunction require a multidisciplinary approach to such patients.

show abstract

Variants of system and organ damage in patients with various thrombotic microangiopathy subtypes in obstetric practice

Balakireva

Kirsanova

Krasnova

et al. 2023

Medicinskij sovet

View full text Add to dashboard Cite

show abstract

Pregnancy outcomes and complications after renal transplantation

Kirsanova,

Kravchenko,

Piliya

et al. 2024

Medicinskij sovet

View full text Add to dashboard Cite

Introduction. Chronic kidney disease (CKD) in pregnancy poses certain risks of both gestational complications and adverse perinatal outcomes, which increase with the decline of renal function.Aim to access pregnancy outcomes in patients who underwent nephrotransplantation.Materials and methods. Retrospective study of pregnant women who gave birth at Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology in the period from 2005 to 2021: 102 pregnancies in 97 patients were analyzed: five recipients had two successful pregnancies.Results. The average age of pregnant women was 31 ± 4.03 years. In equal proportions, patients underwent related or cadaveric kidney transplantation – 52% (n = 53) and 48% (n = 49) of cases, respectively. The average delivery time was 35.5 ± 2.7 weeks. The average weight of newborns was 2545 ± 655 grams. Premature birth (PB) occurred in 47.1%, the average period of birth was 33.4 ± 2.87 weeks, of which early birth (<32 weeks) was 22.5%. The average period of pregnancy after transplantation was 5 ± 3.31 (1–18) years, this period was not associated with obstetric complications or deterioration of graft function. A significant increase in the following parameters was noted during pregnancy: serum creatinine level (p = 0.006), proteinuria (p = 0.003). The glomerular filtration rate also decreased significantly by the end of pregnancy (p = 0.011). Preeclampsia was the leading cause of decreased graft function during pregnancy (32.4%).Conclusions. In general, pregnancy outcomes after nephrotransplantation are favorable, but there is an increased risk of preeclampsia, preterm birth, including operative delivery, urinary tract infection and anemia.

show abstract

Approaches to early detection of atypical hemolytic-uremic syndrome after childbirth

Kirsanova,

Balakireva,

Fedorova

et al. 2024

Medicinskij sovet

View full text Add to dashboard Cite

Introduction. Differentiating conditions accompanied by the development of thrombotic microangiopathy (TMA) in obstetrics is still rather challenging. Our present opinion is that the effect of childbirth on the TMA symptom regression is the key to differential diagnosis. If hemolysis and thrombocytopenia regress after childbirth, we can talk about HELLP syndrome. If not, we should think about atypical hemolytic uremic syndrome (aHUS). aHUS is an extremely rare disease characterized by TMA predominantly involving acute kidney injury. However, the diagnostic task can also be difficult due to possible overlapping one process with another: for example, HELLP syndrome can trigger aHUS, but which of the patients is more susceptible to this transformation is unclear.Aim. To identify clinical and laboratory criteria that can be used to early detect aHUS immediately after childbirth.Materials and methods. A total of 230 patients were enrolled in the study, of whom 71 women were diagnosed with aHUS, 124 patients with HELLP syndrome, and 35 patients without signs of TMA were enrolled in the control group. We assessed and compared the main clinical, anamnestic and laboratory findings.Results. Women with HELLP syndrome and aHUS were comparable in terms of age, frequency of operative delivery and gestational age at delivery, and adverse perinatal outcomes. Peak serum creatinine and LDH values after delivery were the most useful to early predict aHUS. Serum creatinine > 142 μmol/L and LDH > 1391 U/L were associated with the transformation of HELLP syndrome into aHUS.Conclusion. We concluded that standard laboratory data, most specifically peak serum creatinine and LDH, may be used to aid in the early diagnosis of aHUS.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Comparative efficacy of the original and biosimilar eculizumab in the treatment of obstetric atypical hemolytic-uremic syndrome

Cited by 5 publications

References 15 publications

Variants of system and organ damage in patients with various thrombotic microangiopathy subtypes in obstetric practice

Variants of system and organ damage in patients with various thrombotic microangiopathy subtypes in obstetric practice

Pregnancy outcomes and complications after renal transplantation

Approaches to early detection of atypical hemolytic-uremic syndrome after childbirth

Contact Info

Product

Resources

About