chief internal medicine of second level hospital IMSS san luis potosi, San Luis Potosi, Mexico
Background: Kaplan-Meier survival data indicates that at least 50% of patients with acute kidney injury had preeclampsia and were diagnosed with chronic kidney disease 9.9 years later. Chronic hypertension in preeclampsia can lead to heart overload, wich may contribute to herat failure leading to a type 2 cardiorenal syndrome.
Methods: A 27-year-old patient with a history of a 32.3-week gestation pregnancy presents with obstetric emergency complicated by eclampsia, massive obstetric hemorrhage, subarachnoid hemorrhage, acute heart acute that leading to kidney injury, and HELLP syndrome. She was admitted to the ICU with severe hypertension, convulsive crises, and uterine atony that required surgical intervention. After the procedure, complications arose including bilateral pleural effusion, severe anemia, thrombocytopenia, disseminated intravascular coagulation (DIC), and multiple organ failure. A surgical re-intervention was performed due to intra-abdominal bleeding, and multiple transfusions of blood products were administered. Acute kidney injury led to acute heart failure, resulting in Type 3 Cardiorenal Syndrome with preserved ejection fraction (65%), triggered by the presence of pleural effusion. Hemodialysis was performed for the kidney injury, achieving negative fluid balance. Additionally, there was altered diastolic function and severe pulmonary hypertension. The diagnosis also included pneumonia from aspiration and TRALI. Despite intensive management with sedation, ventilatory support, and hemodialysis, the patient continued to have persistent oliguria and deteriorating liver function. During hospitalization, renal function improved, and pulmonary pressure was stabilized, but the patient remained in critical condition. Continuous renal replacement therapy, ventilator adjustments, and pharmacological support were administered.
Outcome: The patient had multiple organ failure triggered by severe eclampsia, cardiorenal syndrome, and TRALI. Despite intensive management, including ventilatory support, hemodialysis, and multiple transfusions, the patient's condition progressed to brain death.
Conclusion: This case highlights the severity of obstetric complications such as eclampsia, Type 3 cardiorenal syndrome, and TRALI, leading to multiple organ failure. Despite intensive management, the patient progressed to brain death, underscoring the importance of early intervention and multidisciplinary management in complex obstetric emergencies.
