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

Prakash, Jai; Pant, Pragya; Singh, Anil Kumar; Sriniwas, Shashidhar; Singh, Vijay Pratap; Singh, Usha

doi:10.3109/0886022x.2015.1062340

Cited by 15 publications

(8 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…29 In a study by Prakash et al incidence of CN was found to be decreasing from 17% in 1982-1991 to 1.4% in 2003-2014. 30 The high incidence of CN in our study is probably due to referral of nonrecovering PRAKI to our center. In our study CN was due to puerperal sepsis (52%), PPH (22.9%), abruptio (20.83%), and TMA (4.1%).…”

Section: Discussionmentioning

confidence: 63%

Pregnancy-related Acute Kidney Injury in Public Hospital in South India: Changing Trends

Sahay

Priyashree

Dogra

et al. 2022

JAPI

View full text Add to dashboard Cite

Background: Pregnancy-related acute kidney injury (PRAKI) is a common problem in the developing world. Materials and methods: In this retrospective observational study at a tertiary care hospital in South India we evaluated records for the maternal, fetal, and renal outcomes in women with PRAKI. Results: Over a 10-year period, 395 patients of PRAKI were seen constituting 8.1% of all acute kidney injury (AKI). The mean age of patients was 27 ± 3 years. A total of 176 (44.5%) had pre-eclampsia, 132 (33.4%) had puerperal sepsis, 76 (19.2%) had antepartum hemorrhage or postpartum hemorrhage (APH 30/PPH 46), nine (2.2%) had hemolytic uremic syndrome (HUS). Obstruction was seen in two patients. Eleven had underlying glomerulonephritis out of three had lupus nephritis. Forty-five of 395 (11.39%) had hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, that is, 25.5% of those with pre-eclampsia. Sixteen (4.0%) had placental abruption. A total of 288 (72.9%) presented postpartum. Renal biopsy done in 103 (26%) showed patchy cortical necrosis (PCN) in 25 (22.3%), diffuse cortical necrosis (DCN) in 23 (20.3%), acute tubular necrosis (ATN) in 20 (19.4%), acute interstitial nephritis (AIN) in 10 (9.7%), while nine (8.7%) had thrombotic microangiopathy (TMA). Glomerular disease was seen in 11. Cortical necrosis (CN) was seen in 48 patients of which 10 (20.83%) had abruption placenta, 25 (52%) had puerperal sepsis, 11 (22.9%) had postpartum hemorrhage (PPH), and two (4.1%) had TMA. A total of 290 (73.4%) required dialysis. About 76% improved while 8.3% progressed to end-stage renal disease (ESRD). Maternal mortality (MM) was 5%. There were 42 intrauterine deaths and 30 deaths in the neonatal period. Discussion: Pregnancy-related acute kidney injury in developing countries is more common as compared to the West. Only 49% patients had booked pregnancy, that is, received regular antenatal care. Apart from pre-eclampsia which is also the major cause in the West and was the etiology in 44% of patients with PRAKI in our study, sepsis (33%) and maternal hemorrhage (19%) were also significant. Immediate recovery from PRAKI was 75% however about 8% develop end-stage kidney disease (ESKD) while in the west ESKD occurred in only about 2%. Conclusion: Pregnancy-related acute kidney injury is an important cause of maternal and fetal morbidity and mortality. Pre-eclampsia emerged as the most common cause of PRAKI and CN was the most common histological lesion. Proper antenatal care and management may improve pregnancy outcomes.

show abstract

Section: Discussionmentioning

confidence: 63%

Pregnancy-related Acute Kidney Injury in Public Hospital in South India: Changing Trends

Sahay

Priyashree

Dogra

et al. 2022

JAPI

View full text Add to dashboard Cite

show abstract

“…Thought to be as a result of severe renal ischemia secondary to hemorrhage or microvascular thrombosis, RCN is encountered in the developing world as a complication of pregnancy 1 . The exact pathogenesis of RCN in the obstetric setting has remained unsolved 2, 3, 4. Hemolysis and microangiopathy have been reported, but were ascribed to disseminated intravascular coagulation, perhaps secondary to sepsis or amniotic fluid embolism.…”

mentioning

confidence: 99%

Postpartum Renal Cortical Necrosis Is Associated With Atypical Hemolytic Uremic Syndrome in Developing Countries

Ramachandran

Nayak

Anakutti

et al. 2019

Kidney International Reports

View full text Add to dashboard Cite

Introduction Pregnancy-related acute kidney injury is the most common cause of renal cortical necrosis (RCN). Atypical hemolytic uremic syndrome (aHUS) as a cause of RCN in pregnant/postpartum is underevaluated. In the current article, we describe a series of cases of pregnancy-related RCN. Methods All cases with acute kidney injury (AKI) in the setting of pregnancy and postpartum state were included. Diagnosis of RCN was made by contrast-enhanced computerized tomography (nonenhancing renal cortex, enhancing medulla, and no excretion of contrast medium) or on a renal biopsy. aHUS was diagnosed in the presence of microangiopathic hemolytic anemia (thrombocytopenia, elevated lactate dehydrogenase with schistocytes on peripheral smear examination, or low haptoglobin). Results A total of 21 (17.5%) patients presented with RCN during pregnancy, all in the postpartum state. Twenty patients (95.2%) showed microangiopathic hemolytic anemia consistent with HUS and 1 (4.8%) patient had biopsy-proven thrombotic microangiopathy. Low complement 3 or activation of an alternate complement pathway was seen in 9 of 15 patients in which it was done. At the end of 6 months, only 2 (9.5%) patients had partial recovery of renal functions, 5 (23.8%) patients died, and 14 remained (66.7%) on hemodialysis. Conclusion The clinical and laboratory features are highly suggestive of aHUS in more than three-fourths of cases with postpartum RCN. Investigations are needed to look for genetic abnormalities in the complement pathway.

show abstract

“…Mortality rates at a single centre in the eastern India have shown a striking decline from 72% (1984-1994) to 19% (1995-2005) in the next decade [1]. In a study conducted by Prakash J, Pant J et al, the incidence of AKI has declined low enough to label it as a disappearing entity [15]. We have however encountered 17 autopsy cases of obstetric RCN of 13896 autopsies performed over a 12 year period at a tertiary care centre at a metropolis.…”

Section: Discussionmentioning

confidence: 99%

Renal cortical necrosis at autopsy: a 12 year experience at a tertiary care centre in Mumbai

Gwendolyn¹,

Sumitha²,

Ellerhea

2017

Int J Med Res Rev

View full text Add to dashboard Cite

Introduction: Renal cortical necrosis (RCN) is an unusual cause of acute renal failure but still causes significant mortality in developing countries. Objective: To review autopsies of histologically proven RCN reported in complete autopsies over the last 12 years. Methods: All autopsies performed from 2004-2016 with RCN were analyzed retrospectively. Results: A total of 13,896 autopsies were done at this centre over this twelve year period from 2004-2016. Of these, 26 cases were diagnosed as RCN, with an incidence of 0.19%. 978 of our total number of autopsies presented with Acute Kidney Injury (AKI) and the incidence of RCN in AKI was 2.7%. There were 844 maternal mortality deaths during this period of which 134 (15.9%) had AKI. RCN accounted for 2% of all maternal mortality deaths during this period. Obstetric cases amounted to 65.4% and non-obstetric cases to 34.6%. Pregnancy induced hypertension; intrauterine foetal death and postpartum hemorrhage were the leading causes of RCN amongst obstetric causes while septicemia, hemolytic uremic syndrome and poisoning were the leading non-obstetric causes. Microscopically, diffuse cortical necrosis was seen in 53.8% autopsies and patchy cortical necrosis was seen in 46.2% autopsies. Histopathology also showed intra-alveolar hemorrhage, bronchopneumonia, cerebral edema and acute respiratory distress syndrome. Conclusion: Our incidence of RCN was 0.19% at general autopsy, 2.7 % in autopsies with AKI and 2% of maternal mortality deaths at a tertiary care centre.RCN in AKI being 2.7% is significantly less than the 6-7% reported in developing countries. Diffuse pattern of cortical necrosis was more common than patchy cortical necrosis.

show abstract

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

Cited by 15 publications

References 22 publications

Pregnancy-related Acute Kidney Injury in Public Hospital in South India: Changing Trends

Pregnancy-related Acute Kidney Injury in Public Hospital in South India: Changing Trends

Postpartum Renal Cortical Necrosis Is Associated With Atypical Hemolytic Uremic Syndrome in Developing Countries

Renal cortical necrosis at autopsy: a 12 year experience at a tertiary care centre in Mumbai

Contact Info

Product

Resources

About