AETIOLOGY, MATERNAL AND FOETAL OUTCOME IN 60 CASES OF OBSTETRICAL ACUTE RENAL FAILURE
AbstractBackground: Acute renal failure is a serious complication in pregnancy. Not only does it result insignificant maternal morbidity and mortality but also results in significant number of foetal loss.Although incidence of obstetrical acute renal failure has decreased in developed countries but still itis one of the major health problem of developing nations. The objective of this study was to studyaetiology, maternal and foetal outcome in obstetrical acute renal failure. Methods: This study wasconducted at Department of Nephrology, Khyber Teaching Hospital, Peshawar from August 2006 toDecember 2007. It was a descriptive, case series study. Female patients with pregnancy and acuterenal failure, irrespective of age, were included in the study. Patients were thoroughly examined andbaseline urea, creatinine, serum electrolytes, peripheral smear, prothrombin time, partialthromboplastin time, fibrinogen degradation products, renal and obstetrical ultrasound wereperformed on each patient and 24-hr urinary protein and bacterial culture sensitivity on blood, urineor vaginal swabs were done in selected patients. Foetal and maternal outcome were recorded. Datawere analysed using SPSS. Results: A total of 60 patients were included in the study. Mean age ofthe patients was 295.4 years and duration of gestation was 334.9 weeks. Mean gravidity was42.2. Sixteen patients (26.66%) were treated conservatively while 44 (73.33%) required dialysis.Postpartum haemorrhage was present in 14 (23.33%), postpartum haemorrhage and disseminatedintravascular coagulation (DIC) in 11 (18.33%), eclampsia-preeclampsia in 8 (13.33%), antepartumhaemorrhage in 8 (13.33%), antepartum haemorrhage with DIC in 6 (10%), DIC alone in 4 (6.66%),obstructed labour in 3 (5%), septic abortion in 3 (3.33%), HELLP (haemolysis elevated liver enzymeand low platelet) in 2 (3.33%), urinary tract infection with sepsis in 1 (1.66%) and puerperal sepsis in1 (1.66%). Foetal loss was 40 (66.66%). Maternal mortality was 9 (15%) while 28 (46.66%) fullyrecovered. Among the rest 6 (30%) had partial recovery and 5 (8.33%) had dialysis dependentchronic kidney disease. Conclusion: Obstetrical acute renal failure not only results in foetal loss butalso causes significant maternal morbidity and mortality.Keywords: Obstetrical acute renal failure, ARF, Aetiology, Foetal outcome, Maternal outcome
Lameire, Van Biesen W, Vanholder R. Acute renal failure.
Agraharkar M, Agraharkar A, Kelly B, Mandayam AS,
Baweja K. Renal disease and pregnancy. [online] 2006 [cited
May 10]. Available from http://www.emedicine.com/
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
Utas C, Yalcindag C, Taskapan H, Guven M, Oymak O,
Yuceosy M. Acute renal failure in Central Anatolia. Nephrol
Dial Transplant 2000;15:152–5.
Parkash 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 single centre experience of 22 years from Eastern
India. Nephrol Dial Transplant 2007;22(4):1213–7.
J Ayub Med Coll Abbottabad 2009;21(4)
Beauregard CD. Obstetrical acute renal failure: A public
health problem in developing countries. Ren Fail
Parkash J, Kumar H, Sinha DK, Kedalaya PG, Pandey LK,
Srivastva PK, et al. Acute renal failure in pregnancy in a
developing country: twenty years of experience. Ren Fail
Chugh KS, Singhal PC, Sharma BK, Pal Y, Mathew MT,
Dhall K, et al. Acute renal failure of obstetric origin. Obstet
and Gynecol 1976;48:642–6.
Ali A, Zaffar S, Mehmood A, Nisar A. Obstetrical acute
renal failure from Frontier Province: A 3 years prospective
study. J Postgrad Med Inst 2004;18(1):109–17.
Naqvi R, Akhter F, Ahmad E, Shaikh R, Ahmad Z, Naqvi A
et al. Acute renal failure of obstetrical origin during 1994 at
one centre. Ren Fail 1996;18(4):681–3.
Ansari MR, Laghari MS, Solangi KB. Acute renal failure in
pregnancy: one year observational study at Liaqat University
Hospital, Hyderabad. J Pak Med Assoc 2008;58(2):61–4.
Selcuk NY, Odabas AR, Cetenkaya R, Tonbol HZ, San A.
Outcome of pregnancies with HELLP syndrome complicated
by acute renal failure (1989–1999). Ren Fail 2000;22:319–27.
Celic C, Gezginc K, Alintepe L, Tonbul HZ, Yaman ST,
Akyurek C, Turk S. Results of the pregnancies with HELLP
syndrome. Ren Fail 2003;25:613–8.
Hachim K, Badahi K, Benghanem M, Fatihi EM, Zahiri K.
Obstetrical acute renal failure. Experience of nephrology
department, Central University Hospital Ibn Rochd,
Casablanca. Nephrologie 2001;22(1):29–31.
Ventura JE, Villa M, Mizraji R, Ferreiros R. Acute renal
failure in pregnancy. Ren Fail 1997;19(2):217–20.
Alexopoulos E, Tambakoudis P, Bili H, Sakellarious G,
Mantalenakis S et al. Ren Fail 1993;15(5):609–13.
Randeree IG, Czarnocki A, Moodley J, Seedat YK, Naiker
IP. Acute renal failure in pregnancy in South Africa. Ren Fail