Acute kidney injury in patients with HELLP syndrome

  • Wenling Ye
  • Hong Shu
  • Yang Yu
  • Hang Li
  • Limeng Chen
  • Juntao Liu
  • Xue-mei LiEmail author
Nephrology - Original Paper



To evaluate the risk factors and renal prognosis of acute kidney injury (AKI) in patients with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome.


Women with HELLP syndrome over a 15-year period at Peking Union Medical College Hospital, China, were retrospectively studied.


A total of 108 patients with HELLP syndrome were included. Fifty-two (48.1%) patients were diagnosed with AKI (median serum creatinine, 139.72 µmol/L; range, 89.00–866.00); 11 (21.2%) required hemodialysis. The AKI group had significantly more multiparity (p = 0.034), hemorrhage > 400 mL (p = 0.027), severe systolic hypertension ≥ 160 mmHg (p = 0.005), infection (p < 0.001), and low hemoglobin (p = 0.002) than non-AKI patients. Multivariate logistic regression showed that infection (OR 36.441, 95% CI 3.819–347.732, p = 0.002), severe systolic hypertension (OR 5.295, 95% CI 1.795–15.620, p = 0.003), and low hemoglobin (OR 0.960, 95% CI 0.932–0.988, p = 0.006) were independent risk factors for AKI. Six patients with AKI died (mortality rate: 11.5%); no death occurred among patients without AKI. In addition to infection (OR 16.268, CI 1.334–198.385, p = 0.029) and eclampsia (OR 69.895, CI 2.834–1723.910, p = 0.009), elevated serum creatinine (OR 1.006, CI 1.001–1.011, p = 0.031) was an independent predictor of maternal mortality. Renal function in 43 (82.7%) patients completely recovered. Two (3.8%) patients developed chronic renal dysfunction after 1 to 2 years of follow-up.


Elevated creatinine was an independent predictor of maternal mortality in HELLP syndrome. AKI severely affects renal prognosis and mortality in pregnant women. The occurrence of AKI was related to infection, severe hypertension, and renal ischemia.


HELLP syndrome Acute kidney injury Outcome Pregnancy 



We are indebted to staff from the Department of Gynaecology and Obstetrics at the Peking Union Medical College Hospital for treatment and diagnostic support. We also thank Ellen Knapp, PhD, and Rebecca Tollefson, DVM, from Liwen Bianji, Edanz Group China (, for editing the English text of drafts of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declares that they have no conflict of interest.

Ethical approval

All procedures performed in studies were in accordance with the ethical standards of the Ethics Committee at Peking Union Medical College Hospital and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


  1. 1.
    Vigil-De Gracia P, Rojas-Suarez J, Ramos E, Reyes O, Collantes J, Quintero A, Huertas E, Calle A, Turcios E, Chon VY (2015) Incidence of eclampsia with HELLP syndrome and associated mortality in Latin America. Int J Gynaecol Obstet 129(3):219–222. CrossRefGoogle Scholar
  2. 2.
    Erdemoglu M, Kuyumcuoglu U, Kale A, Akdeniz N (2010) Factors affecting maternal and perinatal outcomes in HELLP syndrome: evaluation of 126 cases. Clin Exp Obstet Gynecol 37(3):213–216Google Scholar
  3. 3.
    Gupta A, Ferguson J, Rahman M, Weber-Shrikant E, Venuto R (2012) Acute oliguric renal failure in HELLP syndrome: case report and review of literature. Renal Fail 34(5):653–656. CrossRefGoogle Scholar
  4. 4.
    Karumanchi SA, Maynard SE, Stillman IE, Epstein FH, Sukhatme VP (2005) Preeclampsia: a renal perspective. Kidney Int 67(6):2101–2113. CrossRefGoogle Scholar
  5. 5.
    Abildgaard U, Heimdal K (2013) Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. Eur J Obstet Gynecol Reprod Biol 166(2):117–123. CrossRefGoogle Scholar
  6. 6.
    Abraham KA, Connolly G, Farrell J, Walshe JJ (2001) The HELLP syndrome, a prospective study. Renal Fail 23(5):705–713CrossRefGoogle Scholar
  7. 7.
    Gedik E, Yucel N, Sahin T, Koca E, Colak YZ, Togal T (2017) Hemolysis, elevated liver enzymes, and low platelet syndrome: outcomes for patients admitted to intensive care at a tertiary referral hospital. Hypertens Pregnancy 36(1):21–29. CrossRefGoogle Scholar
  8. 8.
    Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA (1993) Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 169(4):1000–1006CrossRefGoogle Scholar
  9. 9.
    Gul A, Aslan H, Cebeci A, Polat I, Ulusoy S, Ceylan Y (2004) Maternal and fetal outcomes in HELLP syndrome complicated with acute renal failure. Renal Fail 26(5):557–562CrossRefGoogle Scholar
  10. 10.
    Martinez de Ita AL, Garcia Caceres E, Helguera Martinez AM, Cejudo Carranza E (1998) Acute renal insufficiency in HELLP syndrome. Ginecologia y obstetricia de Mexico 66:462–468Google Scholar
  11. 11.
    Huang C, Chen S (2017) Acute kidney injury during pregnancy and puerperium: a retrospective study in a single center. BMC Nephrol 18(1):146. CrossRefGoogle Scholar
  12. 12.
    Selcuk NY, Odabas AR, Cetinkaya R, Tonbul HZ, San A (2000) Outcome of pregnancies with HELLP syndrome complicated by acute renal failure (1989–1999). Renal Fail 22(3):319–327CrossRefGoogle Scholar
  13. 13.
    Drakeley AJ, Le Roux PA, Anthony J, Penny J (2002) Acute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit. Am J Obstet Gynecol 186(2):253–256CrossRefGoogle Scholar
  14. 14.
    Randeree IG, Czarnocki A, Moodley J, Seedat YK, Naiker IP (1995) Acute renal failure in pregnancy in South Africa. Renal Fail 17(2):147–153CrossRefGoogle Scholar
  15. 15.
    Sibai BM (2004) Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol 103(5 Pt 1):981–991. CrossRefGoogle Scholar
  16. 16.
    Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012) KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int 2(Suppl):1–138Google Scholar
  17. 17.
    Sabau L, Terriou L, Provot F, Fourrier F, Roumier C, Caron C, Susen S, Ducloy-Bouthors AS (2016) Are there any additional mechanisms for haemolysis in HELLP syndrome? Thrombosis Res 142:40–43. CrossRefGoogle Scholar
  18. 18.
    Sibai BM, Barton JR (2007) Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynecol 196(6):514.e511–514.e519. CrossRefGoogle Scholar
  19. 19.
    Sibai BM, Ramadan MK (1993) Acute renal failure in pregnancies complicated by hemolysis, elevated liver enzymes, and low platelets. Am J Obstet Gynecol 168(6 Pt 1):1682–1687; discussion 1687–1690CrossRefGoogle Scholar
  20. 20.
    Abramovici D, Friedman SA, Mercer BM, Audibert F, Kao L, Sibai BM (1999) Neonatal outcome in severe preeclampsia at 24 to 36 weeks’ gestation: does the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome matter? Am J Obstet Gynecol 180(1 Pt 1):221–225CrossRefGoogle Scholar
  21. 21.
    Martin JN Jr (2013) Milestones in the quest for best management of patients with HELLP syndrome (microangiopathic hemolytic anemia, hepatic dysfunction, thrombocytopenia). Int J Gynaecol Obstet 121(3):202–207. CrossRefGoogle Scholar
  22. 22.
    Erkurt MA, Berber I, Berktas HB, Kuku I, Kaya E, Koroglu M, Nizam I, Bakirhan FA, Ozgul M (2015) A life-saving therapy in class I HELLP syndrome: therapeutic plasma exchange. Transfus Apheresis Sci 52(2):194–198. CrossRefGoogle Scholar
  23. 23.
    Simetka O, Klat J, Gumulec J, Dolezalkova E, Salounova D, Kacerovsky M (2015) Early identification of women with HELLP syndrome who need plasma exchange after delivery. Transfus Apheresis Sci 52(1):54–59. CrossRefGoogle Scholar
  24. 24.
    Jacquemyn Y, Jochems L, Duiker E, Bosmans JL, Van Hoof V, Van Campenhout C (2004) Long-term renal function after HELLP syndrome. Gynecol Obstet Investig 57(2):117–120. CrossRefGoogle Scholar
  25. 25.
    Prakash J, Ganiger VC, Prakash S, Iqbal M, Kar DP, Singh U, Verma A (2018) Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014–2016). J Nephrol 31(1):79–85. CrossRefGoogle Scholar
  26. 26.
    Gopalakrishnan N, Dhanapriya J, Muthukumar P, Sakthirajan R, Dineshkumar T, Thirumurugan S, Balasubramaniyan T (2015) Acute kidney injury in pregnancy—a single center experience. Renal Fail 37(9):1476–1480. CrossRefGoogle Scholar
  27. 27.
    Aggarwal RS, Mishra VV, Jasani AF, Gumber M (2014) Acute renal failure in pregnancy: our experience. Saudi J Kidney Dis Transpl 25(2):450–455CrossRefGoogle Scholar
  28. 28.
    Ospina-Tascon GA, Nieto Calvache AJ, Quinones E, Madrinan HJ, Valencia JD, Bermudez WF, Carvajal J, Escobar MF, de Backer D (2017) Microcirculatory blood flow derangements during severe preeclampsia and HELLP syndrome. Pregnancy Hypertension 10:124–130. CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Wenling Ye
    • 1
  • Hong Shu
    • 2
  • Yang Yu
    • 1
  • Hang Li
    • 1
  • Limeng Chen
    • 1
  • Juntao Liu
    • 3
  • Xue-mei Li
    • 1
    Email author
  1. 1.Department of Nephrology, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  2. 2.Department of NephrologySecond Hospital of Lanzhou UniversityLanzhouChina
  3. 3.Department of Gynaecology and Obstetrics, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina

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