Surgery to remove kidney stones triggers aHUS in woman, 46
Case highlights 'critical need' to promptly ID postoperative complications
Atypical hemolytic uremic syndrome (aHUS) can occur as a rare complication of surgery involving the urinary tract, according to a report from Italy detailing the case of a woman in her 40s who developed the condition after undergoing a procedure to remove kidney stones.
The patient, who had a history of kidney stones, underwent retrograde intrarenal surgery, or RIRS — a minimally invasive surgical technique used primarily in such cases — which was deemed successful. However, she then started showing signs of kidney injury.
The woman required a transfer to the intensive care unit (ICU), where she received various treatments before testing confirmed the diagnosis of aHUS.
According to the researchers, “this case highlights the critical need for prompt recognition and management of aHUS as a postoperative complication, particularly in the context of endourological [urinary tract] procedures.”
The report, “A Rare Case of Atypical Haemolytic Syndrome Following Right Retrograde Intrarenal Surgery (RIRS),” was published in the journal Cureus.
aHUS is an immune system condition marked by hemolytic anemia — which occurs when red blood cells are destroyed faster than they are made — as well as acute kidney failure and thrombocytopenia, or low levels of platelets that help the blood to clot.
The rare disease is typically associated with a dysregulation of the complement cascade, a group of immunological proteins that help fight off infections. Complement overactivation can be driven by genetic factors, but it also can be triggered by external factors, such as pregnancy, infection, and surgery.
While most surgery-related cases of aHUS are associated with transplants, a research team from a hospital in Rome now described the first ever documented case of the condition developing following RIRS.
Women had history of kidney stones, but no previous surgery for them
The patient, a 46-year-old woman, had experienced recurrent kidney stones associated with colic pain, starting in 2021. The stones, however, passed spontaneously.
In February 2024, a CT scan revealed the presence of a stone in the center of her right kidney. Three months later, she underwent right RIRS. The procedure was uneventful, successfully clearing 80% of the stone, the team noted.
However, the next day, the woman suddenly developed fever, chills, low blood pressure, and oliguria, a condition marked by low urine production, progressing to septic shock.
Lab work showed signs of acute kidney injury, hemolytic anemia, and thrombocytopenia, leading to a suspicion of aHUS.
“Despite initial stabilization efforts, the patient’s condition deteriorated, necessitating transfer to the intensive care unit,” the researchers wrote.
The woman underwent a battery of diagnostic tests to look for various types of thrombotic microangiopathy (TMA), a category of diseases that encompasses aHUS and other disorders.
While waiting for the results but working under the suspicion of a TMA, clinicians decided to perform plasma exchange and administer the widely approved aHUS treatment Soliris (eculizumab). Corticosteroids also were given.
Test results ruled out other types of TMA, so plasma exchange therapy was stopped.
Preventive treatment given before follow-up procedure
In the ICU, the patient received supportive care for septic shock and multiorgan dysfunction. These included blood support, tailored antibiotic therapy, and continuous renal replacement therapy (CRRT) to address acute kidney failure.
Further lab work confirmed the aHUS diagnosis.
Over the course of the woman’s hospitalization, significant clinical improvement was noted. By day 10 of her hospital stay, her hemoglobin levels, platelet counts, and renal function had normalized. Hemoglobin is the oxygen-carrying protein inside red blood cells.
This case expands the clinical spectrum of aHUS triggers and emphasizes the importance of recognizing [disease-related complications] even after nontransplant [urinary tract procedures], especially when hematological [blood] abnormalities emerge rapidly postoperatively.
Two months after RIRS, she underwent stone-free right percutaneous nephrolithotripsy (PCNL), another surgical procedure to remove the remaining kidney stones. To reduce the risk of aHUS recurrence, she was given preventive treatment with Soliris three days before undergoing PCNL. She remained symptom-free in follow-up visits, the researchers noted.
“This case expands the clinical spectrum of aHUS triggers and emphasizes the importance of recognizing thrombotic microangiopathy even after nontransplant genitourinary interventions, especially when hematological [blood] abnormalities emerge rapidly postoperatively,” the researchers wrote.
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