Acute Renal Failure in Pregnancy: A Prospective Cohort Study

Abstract

Introduction: Pregnancy-related acute renal failure is a common occurrence and is associated with substantial maternal morbidity and mortality in developing countries. It may comprise up to 25% of the referrals to dialysis centres in developing countries. Acute kidney injury in pregnancy bears a high risk of bilateral renal cortical necrosis and resultant chronic renal failure. Acute renal failure in pregnancy follows bimodal relation to period of gestation. First peak is seen in early pregnancy between 7-16 weeks of gestation and second peak occurs in later part of pregnancy and puerperium. The incidence and aetiology are changing over time. Socio-economic and environmental factors are accountable for a regional difference in incidence, aetiology and outcome also. Aim: To analyse the current aetiological factors, clinical spectrum of presentation of Acute Renal Failure (ARF) in pregnancy and to assess its maternal and foetal outcome. Materials and Methods: It was a prospective cohort study of 100 patients presenting with acute renal failure during pregnancy and puerperium which was done at SCB Medical College, Odisha, India. Inclusion criteria were previously healthy pregnant females with sudden oliguria anuria, sudden increase in serum creatinine to more than 1.5 mg/dL or increase in serum creatinine of more than 0.5 mg/dL per day from base line if haemodialysis was indicated. Maternal outcomes were recovery with conservative treatment, dialysis, ICU admission and maternal death. Foetal outcomes were gestational age at delivery, birth weight, stillbirth or perinatal death. All these were recorded. Results: During the first trimester of gestation acute renal failure developed most often due to septic abortion (3%). Preclampsia was the most common cause of acute renal failure (50%) in late third trimester and postpartum periods followed by puerperal sepsis (9%) Abruptio placentae (3%) and Postpartum Haemorrhage (PPH) (5%). Oedema and oliguria were the most common presentation in 81% and 30% of cases. Eighty seven percent recovered with i.v. fluids and diuretics (conservative management), 13% required dialysis, 23% required blood and Fresh Frozen Plasma (FFP), 30% needed ICU admission and 11% died during treatment. Foetal outcome were measured in terms of foetal growth restriction (24%), preterm delivery (14%), foetal distress (13%), SNCU admission (23%) and stillbirth (5%). Conclusion: This study concludes that pregnancy related acute renal failure is associated with serious prognosis both for the mother and child. Even though good obstetric care can reduce morbidity and mortality associated with it, these patients require special and intensive care management facility which can bring them better survival rates.