Acute Renal Failure in Pregnancy

Pertuiset, Nathalie; Ganeval, D; Grünfeld, Jean‐Pierre

doi:10.1007/978-1-4613-2619-9_10

Cited by 18 publications

(33 citation statements)

References 47 publications

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“…1,5,13 This trend was noted in the western countries as early as the 1980s. 18,19 Obstetric AKI-related RCN was observed in 26% (patchy 1% and diffuse 25%) of the cases in 1970s in North India. 6 RCN occurred in 18.6% of early pregnancy AKI and 37.8% of late pregnancy AKI.…”

Section: Discussionmentioning

confidence: 99%

Renal cortical necrosis is a disappearing entity in obstetric acute kidney injury in developing countries: our three decade of experience from India

et al. 2015

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Rational: Obstetrical complications are the commonest causes of Renal Cortical Necrosis (RCN). However, the overall incidence of RCN in obstetric acute kidney injury in developing countries has been decreasing in recent years. Objective: The aim of this study was to evaluate the changing profile of RCN in obstetric AKI over the last three decades. Methods: This single center study included patients with biopsy proven renal cortical necrosis over a period of 32 years from 1982 to 2014. The diagnosis of RCN was suspected in patients with prolonged AKI (44 weeks) with absolute anuria in the setting of hemorrhage, hypotension and sepsis; and was confirmed by renal biopsy. The changing pattern in the incidence, etiology and outcome of RCN in patients with obstetric AKI was compared in the three study periods, namely 1982-1991, 1992-2002 and 2003-2014. Results: Over a period of 32 years, RCN was diagnosed in 15/259(5.8%) cases of obstetric AKI. Diffuse and patchy cortical necrosis were noted in 8(53.3%) and 7(46.7%) patients, respectively. RCN occurred in 17%(11/65), 2.4%(3/125) and 1.44%(1/69) patients in 1982-1991, 1992-2002 and 2003-2014, respectively. Septic abortion was commonest cause of RCN in the first two study periods but no case was observed in last decade. The decrease in incidence of RCN over the three decades was statistically significant (p-value50.001). Maternal mortality decreased to zero in 2003-2014 from 72.7% in 1982-1991. Conclusions: The incidence of RCN in obstetric AKI in developing countries has declined low enough to label it as a disappearing entity.

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Section: Discussionmentioning

confidence: 99%

Renal cortical necrosis is a disappearing entity in obstetric acute kidney injury in developing countries: our three decade of experience from India

et al. 2015

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“…More significant renal impairment in HELLP syndrome is usually prerenal in aetiology, secondary to hemorrhagic shock and results in acute tubular necrosis or, occasionally, complete cortical necrosis. These problems are more frequently seen in patients with HELLP syndrome complicated by DIC and abruptio placentae [7].…”

Section: Discussionmentioning

confidence: 99%

Successful transplantation of kidneys from a donor with HELLP syndrome-related death

Flynn¹,

Power²,

Murphy³

et al. 2001

Transplant Int

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We report on the successful use of kidneys procured from a donor with HELLP syndrome. The use of organs from a donor with HELLP syndrome has not been reported previously, perhaps because of the renal complications associated with it. Both recipients have been doing well since renal transplantation, with immediate graft function and acceptable graft function at 2 years of follow-up. In view of the continuing shortage of cadaveric kidneys for transplantation, this report highlights how organs from "marginal" donors should not be discarded without worthy consideration.

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“…6 Obstetric AKI may comprise up to 25% referrals to dialysis centers in these countries and is associated with high maternal and fetal mortality. 7 Acute tubular necrosis (ATN) is the most common pathology with a good prognosis. 7,8 There is a high risk of bilateral renal cortical necrosis and consequently of chronic renal failure in these patients.…”

Section: Introductionmentioning

confidence: 99%

A study of obstetric acute renal injury

Chitale

Shinde

Damle

2018

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONAcute kidney injury is a clinical syndrome characterized by a sudden decline in glomerular filtration rate leading to decreased excretion of nitrogenous waste products like urea, creatinine and other uremic toxins.1 Obstetric AKI is usually caused by septic abortions in early pregnancy and by pregnancy toxemia, antepartum hemorrhage, postpartum hemorrhage and HELLP syndrome in late pregnancy.2,3 Its incidence has decreased in the developed countries to only 1-2.8% due to better antenatal care and rare cases of septic abortion in these countries. 4,5 However, in the developing countries it is still frequent and the incidence is around 4.2-15%. 4 High incidence in developing countries is mainly due to limited inaccessibility of antenatal care and emergency obstetric healthcare facilities.6 Obstetric AKI may comprise up to 25% referrals to dialysis centers in these countries and is associated with high maternal and fetal mortality.7 Acute tubular necrosis (ATN) is the most common pathology with a good prognosis. 7,8 There is a high risk of bilateral renal cortical necrosis and consequently of chronic renal failure in these patients. It is an uncommon event and accounts for only 2% of all cases of AKI with obstetric complications being the most common etiology.3 This study was carried out with the objective of finding the factors leading to obstetric AKI and its outcome. ABSTRACTBackground: Acute renal or kidney injury (AKI) is a clinical syndrome characterized by a sudden decline in glomerular filtration rate leading to decreased excretion of nitrogenous waste products. It continues to be a common problem in developing countries. The aim of this study was to understand AKI characteristics in pregnancy and identify the factors related to its unfavorable outcome. Methods: This prospective study was conducted between January 2014 to December 2017. Out of 1057 patients delivered in our institute during this period, out of which 26 patients with Obstetric AKI were included in this study. Results: Incidence of obstetric AKI was 2.64 %. Their age varied from 19 to 34 years, with an average of 26.2 years. About 21(80.8%) patients had not received antenatal care. The main causes of AKI were obstetric hemorrhage (38.46%) and puerperal sepsis (15.38%). The outcome was favorable with complete renal function recovery in 55.76% patients. Two (7.69 %) patients became dialysis dependent. Maternal mortality was one (3.84%). Conclusions: Obstetric AKI is a critical situation in developing countries. Lack of antenatal care (80.8%) is a major contributing factor for obstetric-related complications leading to renal failure. Obstetric hemorrhage (38.46 %) is the most common cause of obstetric AKI. Late referral in 9 (34.61%), puerperal sepsis in three (33.33%), obstetric hemorrhage in three (33.33%) and combined sepsis and hemorrhage in two (27.77%) are the common contributing factors leading to its unfavorable outcomes as maternal morbidity and mortality. Hence, a multidisciplinary approach is warranted to prevent such an a...

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Acute Renal Failure in Pregnancy

Cited by 18 publications

References 47 publications

Renal cortical necrosis is a disappearing entity in obstetric acute kidney injury in developing countries: our three decade of experience from India

Renal cortical necrosis is a disappearing entity in obstetric acute kidney injury in developing countries: our three decade of experience from India

Successful transplantation of kidneys from a donor with HELLP syndrome-related death

A study of obstetric acute renal injury

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