Acute Renal Failure in Pregnancy, its Causes and Outcome, 1 Year Study at Shaikh Zayed Hospital Lahore

Abstract

Abstract

Objective:  The objective of this study was to deter-mine the frequency, etiology, clinical course and out-come of pregnancy related acute renal failure.

Type of Study:  Observational and prospective hos-pital based study.

Place of Study:  Department of Nephrology, Shaikh Zayed Hospital Lahore.

Duration of Study:  One year from November 2010 - October 2011.

Patients and Methods:  Total 210 patients of Acute renal failure (ARF) were admitted with 92 (44%) males and 118 (56%) females during this period of which 40 (19%) females were pregnancy related ARF that were included in this study. A Pre-designed pro-forma was used. The clinical history and physical exa-mination was carried out. Relevant laboratory tests were performed. Renal biopsy was done in few cases. The final outcome was recorded. Twenty four (24) patients were from rural community of Punjab pro- vince and remaining (16) were from urban areas.

Results:  Pregnancy related ARF occurred in forty (40) patients. Twenty two (55%) were multi-para and 18 (45%) were primigravida. Their age was between 29 ± 4.5 years. Majority 32 (80%) patients had not received any antenatal care as compared to 8 (20%) patients  who had adequate antenatal care. Twelve cases (15%) presented in their first and second tri-mester of pregnancy while 28 (70%) patients deve-loped ARF in their third trimester or the puerperium. Twenty four (60%) patients were anuric. Antepartum hemorraghe (APH) in 2 (5%) cases, postpartum hemo-rraghe (PPH) in 6 (15%) cases, Septic abortion in 6 (15%), puerperal sepsis in 8 (20%) and DIC in 4 (10%) cases, Intra-uterine fetal death (IUD) in 12 (30%) and HELLPS in 2 (5%) cases. Sepsis was the commonest cause of ARF. Thirty four (85%) patients received hemodialysis and 6 (15%) did not require any dialysis. Commonest clinical diagnosis was acute tub-ular necrosis (ATN). Complete recovery was seen in 8 (20%) cases .Acute renal cortical necrosis was seen in 14 (35%) cases and 18 (45%) patients had patchy cortical necrosis. Overall mortality was 30%.

Conclusion:  Pregnancy related acute renal failure has high mortality and morbidity. In addition to acute tub-ular necrosis (ATN) as a leading cause with reversible ARF, cortical necrosis contributes significantly to the permanent loss of kidney functions. It is a major health problem especially in the villages of Punjab province. Major identified issues are lack of poor healthcare facilities, fewer numbers of antenatal clinics and lack of prompt management of potentially reversible ARF.

Key Words:  Acute renal failure, Pregnancy.