Post‐partum Renal Failure. ? The Generalized Shwartzman Reaction

SUMMARY Three cases of post‐partum acute renal failure are described, the clinical and pathological features of which are identical to those previously reported. Renal failure accompanied by micro‐angiopathic hremolytic anæmia occurred after a non‐specific prodromal illness early in the puerperium. The features of the disease closely resemble those of thrombotic thrombocytopenic purpura and the hæmolytic uræmic syndrome of children and adults. The similarity of the hæmatological and histological features to their counterparts in the generalized Shwartzman reaction (GSR) is striking. Pregnancy predisposes humans to the GSR, a modification of which may play a part in the pathogenesis of this disease. The prognosis in the cases described and those previously reported is bad because of the irreversible nature of the renal and other pathological changes. Heparin therapy may be of value if given early but clinical recognition of the condition may not occur soon enough.