Several recent reports have called attention to a newly recognized syndrome of irreversible postpartum renal failure and microangiopathic hemolytic anemia that develops following normal pregnancy.1-6 The cause of renal failure and its relationship to the accompanying hemolysis remain unknown. A patient with this syndrome eventually required bilateral nephrectomy for control of malignant hypertension. The pathologic findings and postoperative course in this case suggest that the renal abnormalities may play a prominent role in the production of the fragmented red blood cells and hemolysis observed in this syndrome.
A 20-year-old woman in the eighth month of her first pregnancy was hospitalized in December 1968, for evaluation of proteinuria. Mild proteinuria, ankle edema, and a hematocrit value of 30% were first noted in August 1968, during her first trimester of pregnancy. Blood pressure at that time was 110/70 mm Hg. Treatment with a low sodium diet, vitamins, oral diuretics,