Document Detail


Etiology and outcome of acute renal failure in pregnancy.
MedLine Citation:
PMID:  19889269     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the etiology and outcome of Acute Renal Failure (ARF) in pregnancy. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Nephrology Department of the Jinnah Postgraduate Medical Centre, Karachi, from August 2007 to July 2008. METHODOLOGY: Pregnant women who were healthy previously and had developed ARF, diagnosed on oliguria (urine output <400 ml/day) and mounting azotemia (serum creatinine > 2 mg%) were included in the study. Percutaneous renal biopsy was performed for delayed recovery, i.e. after three weeks. Patients were followed up for a period of 6 months. Percentages were calculated for qualitative variables i.e. causes of ARF, mortality, morbidity and outcome in form of complete recovery, partial recovery, demise and non-recovery. RESULTS: A total of 43 patients with pregnancy-related ARF were included in the study. The puerperal group comprised 36 patients (83.7%). Haemorrhage was the etiology for ARF in 25 (58.1%), antepartum haemorrhage APH in 8 (18.6%) and postpartum haemorrhage PPH in 16 (37.2%) of patients. In 12 (27.9%), puerperal sepsis was the etiological factor, while 4 (9.3%) patients had DIC on presentation. Pre-eclampsia, eclampsia and HELLP syndrome accounted for 5 (11.6%). While 1 (2.3%) was diagnosed with hemolytic uremic syndrome and another one was diagnosed as ARF secondary to hypotension produced by hyperemesis gravidarum. Renal biopsy was performed in 31 patients showing that 10 had acute cortical necrosis and 21 had acute tubular necrosis. Maternal mortality was 16.2% (n=7). Of the 36 (83.7%) surviving patients, 18 (41.4%) had complete recovery of renal function; 12 (27.9%) had partial recovery; and 6 (13.9%) required chronic dialysis. CONCLUSION: Pregnancy-related ARF was associated with poor outcome. Antepartum and postpartum haemorrhage were the most common cause of ARF in pregnancy.
Authors:
Irfana Hassan; Abdul Manan Junejo; Manohar Lal Dawani
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the College of Physicians and Surgeons--Pakistan : JCPSP     Volume:  19     ISSN:  1022-386X     ISO Abbreviation:  J Coll Physicians Surg Pak     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-05     Completed Date:  2010-01-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9606447     Medline TA:  J Coll Physicians Surg Pak     Country:  Pakistan    
Other Details:
Languages:  eng     Pagination:  714-7     Citation Subset:  IM    
Affiliation:
Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi. dr_irfana_hassan@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Female
Humans
Kidney Failure, Acute / etiology*,  mortality
Pakistan / epidemiology
Postpartum Hemorrhage / epidemiology
Pre-Eclampsia / epidemiology
Pregnancy
Pregnancy Complications / etiology*,  mortality
Pregnancy Outcome
Risk Factors
Young Adult

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