OBSTETRICAL ASSOCIATED RENAL, CORTICAL NECROSIS: THOUGH UNCOMMON BUT NOT RARE!

Authors

  • Akhtar Ali
  • Mahrukh Ayesha Ali
  • Mohammad Usman Ali

Abstract

Background: Renal cortical necrosis (RCN) carries high morbidity and mortality in South East Asia.The purpose of this study was to look specifically at the incidence of obstetrical related RCN in renalbiopsies and to evaluate its precipitating factors. In addition, prognosis, impact of aetiology andoutcomes on discharge were also considered. Methods: The study was conducted in the Department ofNephrology, Lady Reading Hospital Peshawar, Pakistan. Renal biopsies of 1,670 patients wereanalysed during the study period of 1998 to 2008. All the patients with obstetrical related RCN wereincluded. Patient records, demographic data, urine output on admission and preceding history of antepartum haemorrhage (APH), post-partum haemorrhage (PPH), septicaemia, operative interventions andretained product of conception (ROPC) was noted and need for dialysis was considered. Results: Outof 1670 kidney biopsies analysed, 48 turned out to be RCN. Among them 39 patients (81.3%) haddiffuse cortical necrosis, 6 patients (12.5%) had patchy cortical necrosis with ATN while 3 patients(6.3%) had predominant ATN with partial patchy cortical necrosis. Out of 48 patients, 25 (52.1%) wereoliguric, 18 (37.5%) were anuric while 5 (10.4%) had urine output >800 ml 24 hr. Operativeinterventions were found in 29 patients while 19 patients had normal vaginal delivery (NVD). 16(55.2%) patients with operative intervention had PPH. Thus the association proved to be significant (p=0.037). Conclusion: Overall incidence of RCN was 2.9%. Oliguria/anuria on admission and dialysisdependency are associated with RCN. PPH and history of operative intervention have significantassociation and are contributing factors to development of RCN.Keywords: Renal cortical necrosis (RCN), post-partum haemorrhage (PPH), ante-partum haemorrhage(APH), acute renal failure (ARF), dialysis

References

Stratta P, Canavese C, Dogliani M, Todros T, Gagliardi L,

Vercellone A. Pregnancy related acute renal failure. Clin Nephrol

;32(1):14–20.

Stratta P, Besso L, Canavese C, Grill A, Todros T, Benedetto C,

et al. Is pregnancy related acute renal failure a disappearing

clinical entity? Ren Fail 1996;18:575–84.

Grunfeld JP, Pertuiset N. Acute renal failure in pregnancy: 1987.

Am J Kidney Dis 1987;9:359–62.

Ali A, Zaffar S, Mehmood A, Nisar A. Obstetrical Acute Renal

Failure from Frontier Province: A 3 Years Prospective Study,

JPMI 2004;18(1):109–16

Ali A, Ali MA, Ali MU, Mohammad S. Hospital Outcomes of

Obstetrical-Related Acute Renal Failure in a Tertiary Care

Teaching Hospital, Journal of Renal Failure 2011, Vol. 33, No. 3

, Pages 285–90

Naqvi R, Akhtar F, Ahmed E, Shaikh R, Ahmed Z, Naqvi A, et

al. Acute renal failure of obstetrical origin during 1994 at one

center. Ren Fail 1996;18:681–3.

Hassan I, Junejo AM, Dawani ML. Etiology and outcome of

acute renal failure in pregnancy. J Coll Physicians Surg Pak

;19:714–7.

Prakash J, Tripathi K, Pandey LK, Gadela SR, Usha. Renal

cortical necrosis in pregnancy-related acute renal failure. J Indian

Med Assoc 1996;94:227–9.

Mattar F, Sibai BM. Eclampsia. VIII. Risk factors for maternal

morbidity. Am J Obstet Gynecol 2000;182:307–12.

Grunfeld JP, Ganeval D, Bournerias F. Acute renal failure in

pregnancy. Kidney Int 1980;18:179–91.

Schreiner GE. Bilateral cortical necrosis. In: Hamburger J,

Crosnier J, Grunfeld JP (Eds): Nephrology. New York: Wiley:

p 411–30.

Matlin RA, Gary NE. Acute cortical necrosis. Case report and

review of the literature. Am J Med 1974;56:110–8.

Kleinknecht D, Grunfeld JP, Gomez PC, Moreau JF, GarciaTorres R. Diagnostic procedures and long-term prognosis in

bilateral renal cortical necrosis. Kidney Int 1973;4:390–400.

Rabbani MA, Shah SMA, Ahmad A, Moolani M. Acute Renal

Cortical Necrosis –A Case Report and Review of Literature. J

Coll Physicians Surg Pak 2001;11:337–9.

Laurel DP, Schreiner GE. Bilateral renal cortical necrosis. Am J

Med 1958;24:519–25.

Deutsch V, Frankl O, Drory Y, Eliahou H, Braf ZF. Bilateral

renal cortical necrosis with survival through the acute phase with

a note on the value of selective nephroangiography. Am J Med

;50:828–34.

Mjahed K, Alaoui SY, Barrou L. Acute renal failure during

eclampsia: incidence risks factors and outcome in intensive care

unit. Ren Fail 2004;26:215–21.

Drakeley AJ, Le Roux PA, Anthony J, Penny J. Acute renal

failure complicating severe preeclampsia requiring admission to

an obstetric intensive care unit. Am J Obstet Gynecol

;186:253–6.

Gul A, Aslan H, Cebeci A, Polat I, Ulusoy S, Ceylan Y. Maternal

and fetal outcomes in HELLP syndrome complicated with acute

renal failure. Ren Fail 2004;26:557–62.

Silva GB, Jr., Monteiro FA, Mota RM, Paiva JG, Correia JW,

Bezerra Filho JG, et al. Acute kidney injury requiring dialysis in

obstetric patients: a series of 55 cases in Brazil. Arch Gynecol

Obstet 2009;279:131–7.

Prakash J, Tripathi K, Pandey LK, Sahai S, Usha, Srivastava PK.

Spectrum of renal cortical necrosis in acute renal failure in

eastern India. Postgrad Med J 1995;71(834):208–10.

Chugh KS, Singhal PC, Kher VK, Gupta VK, Malik GH,

Narayan G, et al. Spectrum of acute cortical necrosis in Indian

patients. Am J Med Sci 1983;286(1):10–20.

Sakhuja V, Chugh KS. Renal cortical necrosis. Int J Artif Organs

;9(3):145–6.

Prakash J, Sen D, Kumar NS, Kumar H, Tripathi LK, Saxena

RK. Acute renal failure due to intrinsic renal diseases: review of

cases. Ren Fail 2003;25:225–33.

Prakash J, Vohra R, Wani IA, Murthy AS, Srivastva PK, Tripathi

K, et al. Decreasing incidence of renal cortical necrosis in

patients with acute renal failure in developing countries: a singlecentre experience of 22 years from Eastern India. Nephrol Dial

Transplant 2007;22:1213–7.

Kazi JI, Mubarak M, Akhter F, Ahmed E, Naqvi R, Naqvi SA, et

al. Spectrum of pathological lesions in acute renal failure. J Coll

Physicians Surg Pak 2003;13(1):22–4.

Ansari MR, Laghari MS, Solangi KB. Acute renal failure in

pregnancy: one year observational study at Liaquat University

Hospital, Hyderabad. J Pak Med Assoc 2008;58(2):61–4.

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Published

2010-09-01