Insuffisance Rénale Aigue Obstétricale : Expérience De La Maternité Issaka GAZOBY De Niamey (Niger)

Abstract

Introduction Acute renal failure (ARF) is a serious obstetric complication of pregnancy, a real health problem in developing countries. It is more related to the pathologies of pregnancy affecting the mother rather than the fetus. The purpose of our study was to assess sociodemographic, clinical, therapeutic and evolutionary features in obstetric acute renal failure. Materials and Methods: A cross sectional study of 6 months (August 2015- January 2016) was conducted. The study involved pregnant women over 20- week amenorrhea including the immediate postpartum admitted for acute renal failure. Results: Thirty-two patients were involved. The mean age was 25.21 ± 5.14 years. Most of them were first-time mothers (53.1%). Surrounding hospital exits account for 71.9% of the admissions. 31.25% (N = 10) of the patients did not receive any antenatal care. The main clinical signs at admission were hypertension (86.6%), oliguria (40.5%) and edema syndrome (37.5%). Eclampsia and severe pre-eclampsia represented the causes of the ARF in 68.75% cases. Considering 8 patients (25%) who were supposed to undergo dialysis therapy, only one took the treatment. The average hospital stay was 15.20 ± 7.45 days. Renal function resolved in 68.75% of patients and 15.62% developed chronic renal sequelae. At the end of the study, we recorded 5 cases of maternal deaths and 10 cases of fetal death in utero. Conclusion: Obstetric ARF remains a serious complication of pregnancy for mother and child. It should be noted that hemodialysis was not accessible to all patients who were entitled to it due to lack of financial means. Therefore, regular monitoring of pregnancies should be prioritized, and, if possible, ensure that hemodialysis sessions are funded.

Acute Kidney Failure during Preeclampsia at Parakou University Hospital in Benin in 2019: Diagnostic and Therapeutic Aspects

“…The study allowed us to note that most patients were referred from centers peripheral health (76.92%). This finding is identical to that made by Tondi ZMM, et al who reported that 71.9% of the patients in their series had been referred [19]. This high rate references found both in our study and in the international literature shows the inadequacy of the implementation of a decision tree in our maternity hospitals which explains the references of pregnant women at the stage of complications, a situation that could be avoided.…”

“…Oliguria was objectified in 33.33% of patients. Similar rates had been reported by other authors including Tondi ZMM, et al (40.5%) and Ahoui S, et al (44.71%) [19,7]. For Kabbali N, et al more than half of the patients were in oliguria (57%) [29].…”

“…Nulliparous (46.15%) were the most affected in our study unlike the studies by Arora N, et al in India, Ansari MR, et al in Pakistan and Ngomas J, et al where the multiparous were the most reached with 54.4%, 52% and 57% respectively [21][22][23]. Tondi ZMM, et al reported in their study that 53.1% of patients were first-time mothers [19]. This percentage diversity could be explained by the fact that our study concerned only cases of preeclampsia and according to data from the literature, nulliparity is a risk factor [24] while other studies all involved obstetric AKF cases.…”

“…The average serum creatinine in our study was 164 ± 10.27 mg/L. It is higher than those of Kabbali N, et al (48.41 ± 37.32 mg/L) and Hachim K (95.85 ± 57.36 mg/L) but lower than that reported by Tondi ZMM, et al (352 ± 100 mg/L) [29,26,19]. Creatinine, substance nitrogen comes from the breakdown of creatine, especially present in the muscles.…”

“…Almost 3/4 of the patients in our series (79.49%) had edema. This result is higher than those reported by Keita M, et al in 2018 in Mali (53.3%) and Tondi ZMM, et al (37.5%) [27,19]. These different findings confirm the inconsistency of edemas during preeclampsia.…”