Acute Renal Failure in Pregnancy in a Developing Country: Twenty Years of Experience

Abstract

Acute renal failure (ARF) has become a rare complication of pregnancy in developed countries. The aim of this study was to describe changing trends in pregnancy-related acute renal failure (PR-ARF) in two successive periods; 1982–1991 and 1992–2002. From July1982 to December 2002, 190 cases of PR-ARF were observed in Eastern India (11.6% of total number of ARF needing dialysis). Obstetrical complications were causative factors for ARF in 15% (65/426) and 10% (125/1201) of patients in the two periods, respectively. The incidence of PR-ARF fell from 15% in 1982–1991 to 10% in 1992–2002, with respect to the total number of acute renal failure cases. Post-abortal ARF showed a declining trend, 9% in the 1980s to 7% in the 2000s, of the total number of ARF cases. Preeclampsia-eclampsia was the cause of obstetrical ARF in 23% (1982–1991) and 14.4% (1992–2002) of cases in these two periods. The percentage of total ARF due to eclampsia declined from 3.5% during the period 1982–1991 to 1.4% in 1992–2002. Puerperal sepsis contributed to 0.8% of total ARF in recent years, compared to 2.4% in the earlier period. The incidence of cortical necrosis decreased significantly (p < 0.001) from 17% in 1982–1991 to 2.4% in the 2000s. The maternal mortality reduced to 6.4% in 1992–2002 from initial high mortality of 20% in the period of 1982–1991. Conclusion. PR-ARF which remained high in the initial period has decreased in recent years. This is associated with a declining trend in post‐abortal ARF and a reduction in maternal mortality as well. We noted a significant decrease (p < 0.001) in the incidence of cortical necrosis in PR-ARF. The reasons for this favorable outcome in obstetrical ARF seem to be due to improved medical care, decrease in the number of septic abortions, effective care of obstetrical complications, and legalization of abortion.