Acute Renal Failure In Pregnancy Research Articles

Acute Renal Failure in Pregnancy: A Prospective Cohort Study

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.

Improving the outcomes for pregnancies in the context of kidney disease

Renal disease in pregnancy is a rare pathology, but it raises several problems in terms of normal pregnancy evolution. Among pregnant women with renal injury, the rate of complications such as spontaneous abortion, preeclampsia, hypertension, intrauterine growth restriction, premature birth, fetal and neonatal mortality are much higher. For a good understanding of the pathology and a correct management of pregnant women with renal disease, it is necessary to know the normal pregnancy changes and the differentiation of chronic kidney disease from the acute injuries occurring during pregnancy. It is useful to ensure counseling prior to conception and to perform all prophylactic measures in order to prevent pregnancy complications and subsequent decline in renal function in all cases of pregnant women with chronic renal insufficiency. Treatment of acute renal failure in pregnancy involves therapy of the underlying condition that caused renal injury, prevention of irreversible kidney injury and pre-vention of maternal and fetal secondary complications. Monitoring carefully this cate-gory of pregnant women, although additional risks strike, often results in favorabl pregnancy evolution.

Etiological Spectrum of Pregnancy-Related Acute Renal Failure among Females at a Tertiary Care Hospital

Background: Acute renal failure in pregnancy can be induced by any of the disorders leading to renal failure in the general population, such as acute tubular necrosis due to infection, glomerulonephritis related to lupus, or drug toxicity. There are, however, pregnancy complications characteristic of each trimester that can result in renal failure. The objective of this study was to determine the frequency of various causes of pregnancy-related acute renal failure among females presenting to a tertiary care hospital.

Acute renal failure in pregnancy at a tertiary level hospital in Mumbai: An epidemiological profile

Background: To study the clinical profile of pregnancy related acute renal failure, management and outcome in terms of cure, maternal morbidity and maternal ‐ fetal mortality. Methods: This is a prospective observational study carried out on hospitalized patients in our hospital over a period of fourteen months (August 2007 ‐ September 2008) after approval from the ethical clearance committee. Results: A total of 41 patients, with age ranging between 15 ‐ 45 years. The majority of the patients 25 (60.98%) were multigravida and 16 (39.02%) were primigravida. The bimodal frequency pattern were also observed in our study, first between 19 to 24 weeks of gestation and second around 31 to 36 weeks of gestation. The incidence of PR-ARF was about 1 in 270 pregnancies. Sepsis was the commonest cause of PR-ARF (46.34 %) followed by Toxaemia of Pregnancy (31.69%) and Haemorrhage (14.62%). The incidence of septic abortion as a cause of PR-ARF has declined to 7.31%. Oliguria was the commonest symptom (58.53%). Fluid overload was the most common complication encountered (33.33%). Conclusion: Incidence of PR-ARF is still high in our country as compared to western countries. Multigravidas were more commonly affected than primigravidas. Sepsis was the commonest cause of PR-ARF followed by toxaemia of pregnancy and haemorrhage. Maternal and fetal mortality were high , 17.07 % and 2.43 % respectively.

Acute Renal Failure in Pregnancy

Poster Presentation Background Acute renal failure is a rare, life‐threatening complication of severe preeclampsia and hemolysis elevated liver enzymes and low platelets syndrome (HELLP). This condition occurs in an estimated 1 in 20000 pregnancies. Acute renal failure presents challenges for even the expert nurse. The purpose of this presentation is to assist obstetric nurses in recognizing complications of severe preeclampsia such as acute renal failure and empower them with the knowledge and skills to manage women with this condition to improve outcomes. Case A 25‐year‐old G1P0 woman at 39 weeks gestation arrived in our obstetric triage unit with complaints of a constant headache, visual disturbances, epigastric pain, and contractions for one hour. Initial blood pressure was 190/125 and fetal heart tones were not present on auscultation. After immediate notification to the obstetric (OB) triage attending physician, an intravenous line (IV) was started, lab work was drawn, IV antihypertensive medication was administered, and a magnesium sulfate infusion was started. After evaluation, the woman was diagnosed with an intrauterine fetal demise secondary to superimposed preeclampsia and HELLP syndrome. She was admitted to our labor and delivery unit for induction of labor. Within 24 hours of admission, maternal/fetal medicine, nephrology, neurology, and optometry were consulted. During induction, lab work was ordered every 4 hours and disseminated intravascular coagulation (DIC) was diagnosed, which required multiple blood transfusions. Urine output was minimal and renal lab values were elevated with an initial creatinine of 1.6 that peaked at 7.6. The woman required the placement of a tunnel catheter and dialysis short term while in the hospital. She continued to have complaints of visual disturbances and was diagnosed with retinal detachment related to DIC and preeclampsia. The woman was discharged one week postpartum on oral antihypertensive medication after her course of dialysis was completed. Conclusion Management of this woman with superimposed preeclampsia and HELLP syndrome with complications of DIC and acute renal failure presented a challenge to our health care team. Management required a multidisciplinary team approach to prevent further deterioration of kidney function and kidney disease. Acute renal failure was identified early by the health care team. The collaboration of the health care team and their ability to utilize each other's knowledge and expertise resulted in the woman being on dialysis short term, restoration of her kidney function, and her discharge on oral antihypertensive medication.

Acute renal failure in pregnancy: Our experience

Acute renal failure (ARF) is a serious medical complication during pregnancy, and, in the post-partum period, is associated with significant maternal morbidity and mortality as well as fetal loss. The objective of our study is to find the etiology and maternal outcome of ARF during pregnancy. The study was conducted at the Obstetrics and Gynecology Department of the Institute of Kidney Disease and Research Center, Ahmedabad, India from January 2009 to January 2011. Fifty previously healthy patients who developed ARF, diagnosed on oliguria and serum creatinine >2 mg%, were included in the study. Patients with a known history of renal disease, diabetes and hypertension were excluded from the study. All patients were followed-up for a period of six months. Patient re-cords, demographic data, urine output on admission and preceding history of antepartum hemorrhage (APH), post-partum hemorrhage (PPH), septicemia, operative interventions and retained product of conception were noted and need for dialysis was considered. Patients were thoroughly examined and baseline biochemical investigations and renal and obstetrical ultrasound were performed on each patient and bacterial culture sensitivity on blood, urine or vaginal swabs were performed in selected patients. The age range was 19-38 years (mean 26 ± 3.8). The first trimester, second trimester and puerperal groups comprised of four (8%), 25 (50%) and 21 patients (42%), respectively. Hemorrhage was the etiology for ARF in 15 (30%), APH in ten (20%) and PPH in five (10%) patients. Eleven (22%) patients had lower segment cesarian section (LSCS) while 36 (78%) patients had normal vaginal delivery. In 20 (40%) patients, puerperal sepsis was the etiological factor, while pre-eclampsia, eclampsia and HELLP syndrome accounted for 18 (36%) patients. Two (4%) patients had disseminated intravascular coagulation on presentation while one (2%) patient was diagnosed with hemolytic uremic syndrome. Maternal mortality was 12% (n = 6). Of the 38 (88%) surviving patients, 21 (42%) had complete recovery of renal function, eight (16%) patients had partial and 15 (30%) patients required dialysis on a long-term basis. ARF in pregnancy is associated with poor maternal and renal outcome if not detected and treated in time.

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

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.

Acute renal failure in pregnancy: Tertiary centre experience from north Indian population

Background:Obstetrical acute renal failure ARF is now a rare entity in the developed countries but still a common occurrence in developing countries. Delay in the diagnosis and late referral is associated with increased mortality. This study aimed to evaluate the contributing factors responsible for pregnancy-related acute kidney failure, its relation with mortality and morbidity and outcome measures in these patients.Materials and Methods:Total 520 patients of ARF of various aetiology were admitted, out of these 60 (11.5%) patients were pregnancy-related acute renal failure.Results:ARF Acute renal failure occurred in 32 (53.3%) cases in early part of their pregnancy, whereas in 28 (46.7%) cases in later of the pregnancy. Thirty-two (53.3%) patients had not received any antenatal visit, and had home delivery, 20 (33.4%) patients had delivered in hospitals but without antenatal care and eight (13.3%) patients received antenatal care and delivered in the hospitals. Anuria was observed in 23 (38.3%) cases, remaining 37 (61.7%) cases presented with oliguria. Septicemia was present in 25 (41.7%), hypertensive disorder of pregnancy in 20 (33.3%), haemorrhage in eight (13.3%), abortion in 5 (8.3%), haemolysis elevated liver enzymes low platelets counts (HELLP) syndrome in one (1.67%) and disseminated intravascular coagulation in one (1.67%). (61.7%) patients were not dialyzed, 33 (55%) recovered normal renal function with conservative treatment. Complete recovery was observed in 45 (75%) patients, five (8.4%) patients developed irreversible renal failure. Maternal mortality was nine (15%) and foetal loss was 25 (41.7%).Conclusion:Pregnancy-related ARF is usually a consequence of obstetric complications; it carries very high morbidity and mortality.

Acute renal failure in pregnancy

Acute renal failure (ARF) is a dreaded complication of pregnancy-associated with significant mortality and morbidity. It is important to know the pregnancy specific causes of ARF. The aim is to write a review on the etiology, differential diagnosis, and management of ARF in women during pregnancy and puerperal period. The principles of management must take into consideration the fetal health. The treating physician must have a good knowledge of physiologic changes that occur in pregnancy. With timely diagnosis and multidisciplinary approach both maternal and fetal outcome improves.

Factors predicting the outcome of acute renal failure in pregnancy.

To determine the factors predicting renal outcome in patients developing acute renal failure in pregnancy. Descriptive cohort study. Study was conducted at Nephrology Unit of Sindh Institute of Urology and Transplantation, Karachi, from October 2006 to March 2007. Patients with acute renal failure due to complications of pregnancy, with normal size of both the kidneys on ultrasound were enrolled, and followed for a period of 60 days or until recovery of renal function. Patient's age and parity, presence of antenatal care, type of complication of pregnancy, foetal outcome and duration of oliguria were compared between patients who remained dialysis dependent and those who recovered renal function. Chi-square/Fisher's exact test and student's t-test, were used for determining the association of categorical and continuous variables with dialysis dependency. The mean age was 29+/-6 years. Most patients came from rural areas of interior Sindh. Sixty eight percent did not have antenatal checkups. Antepartum haemorrhage (p=0.002) and prolonged duration of oliguria (35+/-15.7 days, p= < 0.001) were associated with dialysis dependency, which was observed in 50% of the study group. Ante-partum haemorrhage and prolonged oliguria were strong predictors of irreversible renal failure. This highlights the need for early recognition and referral, and the importance of trained birth attendants and antenatal care.

Spontaneous perinephric haemorrhage and acute renal failure in pregnancy due to cocaine intoxication.

Cocaine abuse may contribute to the diverse forms of renal injury. We report a case of a pregnant woman who developed a large subcapsular renal haematoma after cocaine intoxication at 18-week gestation. She stabilized on conservative management and presented again at 29-week gestation with pre-eclampsia, acute renal failure and fetal demise. She required caesarean section delivery and intensive antihypertensive therapy to control severe pre-eclampsia associated with cocaine intoxication. This case is unique in that it is the first report of cocaine intoxication in pregnancy complicated by subcapsular haemorrhage. We discuss the possible mechanisms for the occurrence of this complication.

Sepsis and Acute Renal Failure in Pregnancy

The unique physiology of pregnancy poses several problems for clinicians charged with caring for critically ill pregnant patients. This focused review summarizes two problems encountered in critically ill pregnant patients: pregnancy-related sepsis and acute renal failure. Common causes, and the effects of pregnancy on diagnosis and treatment are discussed.

Etiology and outcome of acute renal failure in pregnancy.

To determine the etiology and outcome of Acute Renal Failure (ARF) in pregnancy. A case series. Nephrology Department of the Jinnah Postgraduate Medical Centre, Karachi, from August 2007 to July 2008. Pregnant women who were healthy previously and had developed ARF, diagnosed on oliguria (urine output <400 ml/day) and mounting azotemia (serum creatinine > 2 mg%) were included in the study. Percutaneous renal biopsy was performed for delayed recovery, i.e. after three weeks. Patients were followed up for a period of 6 months. Percentages were calculated for qualitative variables i.e. causes of ARF, mortality, morbidity and outcome in form of complete recovery, partial recovery, demise and non-recovery. A total of 43 patients with pregnancy-related ARF were included in the study. The puerperal group comprised 36 patients (83.7%). Haemorrhage was the etiology for ARF in 25 (58.1%), antepartum haemorrhage APH in 8 (18.6%) and postpartum haemorrhage PPH in 16 (37.2%) of patients. In 12 (27.9%), puerperal sepsis was the etiological factor, while 4 (9.3%) patients had DIC on presentation. Pre-eclampsia, eclampsia and HELLP syndrome accounted for 5 (11.6%). While 1 (2.3%) was diagnosed with hemolytic uremic syndrome and another one was diagnosed as ARF secondary to hypotension produced by hyperemesis gravidarum. Renal biopsy was performed in 31 patients showing that 10 had acute cortical necrosis and 21 had acute tubular necrosis. Maternal mortality was 16.2% (n=7). Of the 36 (83.7%) surviving patients, 18 (41.4%) had complete recovery of renal function; 12 (27.9%) had partial recovery; and 6 (13.9%) required chronic dialysis. Pregnancy-related ARF was associated with poor outcome. Antepartum and postpartum haemorrhage were the most common cause of ARF in pregnancy.

Sepsis and Acute Renal Failure in Pregnancy

Sepsis and Acute Renal Failure in Pregnancy

Sepsis and Acute Renal Failure in Pregnancy

The unique physiology of pregnancy poses several problems for clinicians charged with caring for critically ill pregnant patients. This focused review summarizes two problems encountered in critically ill pregnant patients: pregnancy-related sepsis and acute renal failure. Common causes, and the effects of pregnancy on diagnosis and treatment are discussed.

Pregnancy: Kidney Diseases and Hypertension

Pregnancy: Kidney Diseases and Hypertension

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

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.

Acute renal failure in pregnancy

To provide an evidence-based, up-to-date review of the literature regarding the assessment and management of acute renal failure that may affect women during pregnancy and the postpartum period. A review of the current literature was performed. Acute renal failure is a rare complication of pregnancy but is associated with significant morbidity and mortality. Management requires knowledge of the renal physiologic changes occurring in pregnancy and the relevant diagnoses, both pregnancy-specific and those that may coincidentally occur with pregnancy. In addition, fetal effects must be taken into consideration. Ideal care for women with acute renal failure in pregnancy or postpartum requires a multidisciplinary approach that may include maternal-fetal medicine, critical care medicine, nephrology, and neonatology specialists.

Testosterone Is Responsible for Enhanced Susceptibility of Males to Ischemic Renal Injury

Female mice are much more resistant to ischemia/reperfusion (I/R)-induced kidney injury when compared with males. Although estrogen administration can partially reduce kidney injury associated with I/R, we demonstrated that the presence of testosterone, more than the absence of estrogen, plays a critical role in gender differences in susceptibility of the kidney to ischemic injury. Testosterone administration to females increases kidney susceptibility to ischemia. Dihydrotestosterone, which can not be aromatized to estrogen, has effects equal to those of testosterone. Castration reduces the I/R-induced kidney injury. In contrast, ovariectomy does not affect kidney injury induced by ischemia in females. Testosterone reduces ischemia-induced activation of nitric oxide synthases (NOSs) and Akt and the ratio of extracellular signal related kinase (ERK) to c-jun N-terminal kinase (JNK) phosphorylation. Pharmacological (Nomega-nitro-L-arginine) or genetic (endothelial NOS or inducible NOS) inhibition of NOSs in females enhances kidney susceptibility to ischemia. Nitric oxide increases Akt phosphorylation and protects Madin-Darby canine kidney epithelial cells from oxidant stress. Antagonists of androgen or estrogen receptors do not affect the gender differences. In conclusion, testosterone inhibits the post-ischemic activation of NOSs and Akt and the ratio of ERK to JNK phosphorylation through non-androgen receptor-medicated mechanisms, leading to increased inflammation and increased functional injury to the kidney. These findings provide a new paradigm for the design of therapies for ischemia/reperfusion injury and may be important to our understanding of the pathophysiology of acute renal failure in pregnancy where plasma androgen levels are elevated.

Care of the critically ill parturient: oliguria and renal failure

The incidence of acute renal failure in pregnancy has decreased. This decrease is less marked in developing countries in which resources are more scarce. The clinical diagnosis of acute renal failure is crude due to the variability of clinical signs and the late occurrence of basic biochemical abnormalities. Obstetric and gynaecological diseases are found among the traditional pre-renal, intra-renal and post-renal causes of acute renal failure. The cornerstone of management is the identification of high-risk cases and the prevention of acute renal failure by maintaining intravascular volume. The evidence for the efficacy of other prophylactic medical interventions, such as the use of loop diuretics, mannitol, low-dose dopamine and others, is poor. Management of established acute renal failure includes restoration of intravascular volume, treatment of any reversible causes, especially pregnancy complications such as pre-eclampsia, strict fluid balance and correction of any electrolyte abnormality or metabolic acidosis. Dialysis is a supportive measure until the kidneys recover.