Pregnancy-related Acute Renal Failure 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.

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 during the pregnancy: a review on pathophysiology, risk factors and management

Acute renal failure (ARF) is a major medical problem during pregnancy with maternal and fetal outcomes. While the trend of pregnancy-related ARF is on a decline due to the advances in obstetrics care and the legality of abortion among developed countries, this situation remains one of the serious health problems in the developing nations. This review aims to evaluate the current studies with regards to pregnancy related ARF pathophysiology, risk factors and treatment. PubMed, Embase, Scopus and directory of open access journals (DOAJ) databases were searched to obtain the information. Most of the studies in this review were conducted in observational, both prospective and retrospective studies. Results demonstrated a variety of major pregnancy-related ARF causes including obstetric hemorrhage, hypertensive disorders in pregnancy, sepsis, thrombotic microangiopathy and acute fatty liver in pregnancy. Aside from awareness of the pathogenesis of pregnancy-related ARF and its risk factors, understanding the physiological renal adaptation during pregnancy is essential for early detection, diagnosis, and proper management to prevent the pregnancy related complications.

The prevalence of pregnancy-related acute renal failure in Asia: A systematic review.

Acute renal failure (ARF) is a major complication during pregnancy and is associated with high mortality rate in developing countries. The aim of this study was to report the prevalence of pregnancy-related ARF in Asia. This study is a systematic review Google Scholar, PubMed, and Medline databases were searched for all papers in English on pregnancy related ARF (PR-ARF) in Asian countries that were published between 2010 and 2015 were reviewed. Of all the articles published in that period, 19 were selected - 17 were original articles and two were cases reports. We gathered information on the prevalence of PR-ARF, parity, duration of pregnancy when PR-ARF developed, etiology of PR-ARF, common clinical symptoms, and laboratory findings in PR-ARF.

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.

Pregnancy related acute renal failure: case report

Pregnancy related acute renal failure: case report

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.

Pregnancy Related Acute Renal Failure in a Tertiary Care Hospital in Bangladesh

Background: Pregnancy related acute renal (PRARF) failure is more common in developing countries than developed country. Improved antenatal care and obstetric care reduce PRARF in developed country. In Bangladesh maternal mortality rate is 3.8/1000 population of which 25% account for acute renal failure. We try to find out cause, risk factor and out come of pregnancy related acute renal failure. Materials and Methods: A prospective observational study was done to observe the status of ARF in pregnancy in Nephrology Department of Dhaka Medical College during 2007-2008. All patients were undergone detail history, clinical examination and investigation and follow up during hospital stay. Data recorded in predesigned case record form. Statistical analysis was done with SPSS soft ware 12.5 package. All data presented as mean or percentage. The Chi square test or Fisher’s exact test was used to compare differences in the frequency of clinical manifestations among cases. P value <0.05 count as significant. Results: Among 57 women, the mean age was 27±6.6 years range from 17-43 years. Sixty seven percent were multrigravidae, 51% (29) was on irregular antenatal care, and 67% below primary level of education. Renal failure occur mainly in 3rd trimester of pregnancy (31.4±7.4 weeks). Common presentation is with generalized swelling (51%)and oligouria (52%) with reduce haemoglobin and leucocytosis. The mean creatinine was 6.7±3mg/dl in this series. Lower uterine caeserian section (LUCS) done in 23% cases. 56.1% had severe renal failure and 47% patients required dialysis. Complete recovery was seen in 63% cases while, 31% died and 6% patient have incomplete recovery with persistent dialysis dependent status. Septicaemia (43%) and eclampsia (19%) were the main cause of PRARF, others causes were PPH, APH, ruptured ectopic pregnancy. In 3% patients, actual cause was not identified. Poor antenatal care (p-0.027 ), severity of renal failure (p-0.066), patient requiring dialysis (p-0.025), LUCS (0.028), septicaemia (p-0.026) and low level of education (0.036) have significant effect on outcome. Conclusion: Pregnancy related acute renal failure is common with increased mortality in our study due to poor antenatal care, low level of education and multiple pregnancy. Improve obstetrical care and Nephrological care may reduce Pregnancy related acute renal failure and mortality. DOI: http://dx.doi.org/10.3329/jom.v13i2.12739 J Medicine 2012; 13 : 129-132

Pregnancy-related acute renal failure in eastern India

Objective To study the causes, burden, and impact of pregnancy-related acute renal failure (PRARF) in a low-resource setting. Methods A prospective observational study of consecutive women admitted to the Seth Sukhlal Karnani Memorial Hospital, Kolkata, India, with PRARF between February 1, 2007, and May 31, 2009, was conducted. The information collected included causes and predisposing conditions leading to PRARF, clinical presentations, medical and obstetric management—including need for dialysis—and maternal outcome. Results The leading causes of PRARF among the 57 participants were sepsis 19 (33.3%), hemorrhage 16 (28.1%), and hypertensive disorders 15 (26.3%). The condition occurred in 11 (19.3%) cases before 20 weeks of gestation, 6 (10.5%) cases after 20 weeks of gestation, and 40 (70.2%) cases during puerperium. Most women were from rural areas and received inadequate prenatal care. Although 40 women had PRARF during puerperium, the precipitating event mostly started during the process of labor/delivery. Despite multidisciplinary care, mortality was high (28.1%); cause-specific fatality was highest with sepsis (36.8%) and hemorrhage (25.0%). Many women who survived experienced prolonged morbidity. Conclusions Pregnancy-related acute renal failure is potentially fatal but largely preventable. Universal prenatal care and greater access to emergency obstetric services, especially in rural India, could avert PRARF and its consequences.

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.

PREGNANCY RELATED ACUTE RENAL FAILURE

Introduction: Acute renal failure (ARF) during pregnancy is rareevent and continues to be common in developing countries. Period: 1998-2005. Setting: Nephro-urology unit atChandka Medical College, Larkana. Study Design: Retrospective study. Patients &amp; Methods: 294 cases of AcuteRenal Failure were treated. Among these cases, 72 (24.5%) were pregnancy related in origin. All of these patients wereknown to be previously healthy. Results: Pregnancy related Acute Renal Failure was associated with, post partumhemorrhage was in 20(27.7%), intra uterine death in 20(27.7%) antipartum hemorrhage was 18(25%), preeclampsiaeclampsia in 8(11.11%) and septic abortion and puerperal sepsis in6(8.3%). Among these patients 65(90.3%) requireddialysis therapy because of moderate to severe azotemia. 35(48.61%) patients recovered normal function. 30(46.15%)developed irreversible renal function. Conclusion: Early reorganization of this disorder, improvement of health infrastructure, antenatal health care and intensive supportive therapy, can reduce maternal and fetal mortality and morbidity.

ACUTE RENAL FAILURE:

Objective: To find out the various causes of acute renal failure (ARF) and its out come in our settingof tertiary Care Hospital in rural areas. Design: A retrospective Study. Setting: Nephro-urology department ChandkaMedical College teaching hospital Larkana. Period: From March 1998 to March 2005. Patients &amp; Methods: Reviewof 294 patients of acute renal failure admitted in Nephro-urology department Chandka Medical College teachinghospital Larkana. Detailed history, physical examination and laboratory data of 294 consecutive patients of acute renalfailure were analyzed. Result: 294 patients were included in this study. Among them149 (51.7%) were in the youngerage group (less than 40 years) with dominance of males (1.61 to 1.00 male to female ratio). Major cause of ARF waspre renal, seen in 172 (66.6%) patients, 70 (23.8%) of all cases of acute renal failure had gynecological and obstetricalback ground. Other causes C.V.A in 24 (9.3%), HHD in 14(4.5%). Glomerulonephritis in 22(8.5%),and obstructiveuropathy in 16(6.2%). 92 Patients (31.3%) improved on conservative treatment,166(56.5%) needed dialysis and36(12.2%) left against medical advice. Conclusion: This data reveals that pre renal element is the single mostimportant cause of acute renal failure, in which commonest cause was pregnancy related ARF followed by C.V.A,HHD,glomerulonephrits and obstructive urophathy. Early indentification, referral treatment of pre renal factors, good perinatal care and good therapeutic measures substantially bring down the incidence of acute renal failure. 12.2% patientsleft against medical advice due to heavy expenses on the treatment and needs NGOs and Government support fortreatment of poor patients.

Pregnancy-related acute renal failure: A single-center experience.

Pregnancy-related acute renal failure (ARF) is a common occurrence and is associated with substantial maternal and fetal mortality. It also bears a high risk of bilateral renal cortical necrosis. We conducted this study to evaluate the contributing factors and to assess the frequency of cortical necrosis. In this prospective study, of the 772 patients with ARF admitted at our institute between January 2004 and May 2006, 70 had ARF associated with pregnancy complications. ARF was diagnosed by documenting oliguria (urine output <400 ml/d) or mounting azotemia in the presence of normal urine output. (serum creatinine >2 mg%). Renal biopsy was performed if a patient was found to be oliguric or required dialysis support at the end of three weeks. The incidence of pregnancy-related ARF was 9.06%. Approximately 20% cases occurred due to postabortal complications in early pregnancy and 80% following complications in late pregnancy. Puerperal sepsis was the most common etiological factor in 61.42% of the patients. Preeclampsia accounted for 28.57% of ARF. Two-thirds of patients recovered with dialysis and supportive care. The incidence of biopsy proven renal cortical necrosis was 14.8% (10 of the 70 patients). The incidence of renal cortical necrosis was 28.57% in the early pregnancy group and 10.71% in the late pregnancy group. Postabortal sepsis was the most common precipitating event for renal cortical necrosis. Maternal mortality was 18.57%. Sepsis accounted for a majority of deaths (61.53%). Pregnancy-related ARF is common in western India. Puerperal sepsis is the most frequent etiological factor. Renal cortical necrosis is common and postabortal sepsis was the most common precipitating event. Sepsis accounted for a majority of maternal mortality.

Pregnancy related acute kidney injury: A single center experience from the Kashmir Valley

All patients admitted with pregnancy related acute renal failure (PRAKI) from June 2005 to May 2007 were studied with respect to etiology, clinical features, and outcome of PRAKI. Of 569 cases of acute kidney injury (AKI), 40 (7.02%) cases were related to gestational problems; the age of the patients ranged from 15 to 45 years. Septic abortion was the most common cause of PRAKI, accounting for 20 (50%) cases of which 15 (75%) cases occurred in the first and five (25%) in the second trimester. Other causes were antepartum hemorrhage: six cases (15%), toxemia of pregnancy: six cases (15%), acute gastroenteritis: three cases (7.5%), postpartum hemorrhage: two cases (5%), acute pyelonephritis: two cases (5%), and postpartum, acute kidney injury: one case (2.5%). Dialysis was needed in 60% of the cases and mortality was observed in 20% of the cases. PRAKI continues to be a major concern in our society, causing a high maternal mortality. Septic abortion which has virtually disappeared from developed countries, continues to be a major cause of PRAKI in our society. Hence, there is a need to halt the practice of illegal abortions and improve antenatal care.

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.

OUTCOME OF PREGNANCIES WITH HELLP SYNDROME COMPLICATED BY ACUTE RENAL FAILURE (1989–1999)

HELLP syndrome, a syndrome of hemolysis, elevated liver enzymes and low platelets may occur in pregnancy with pre-eclampsia/eclampsia, and its a significant complication is acute renal failure (ARF).The aim of study was to determine frequency and outcome of HELLP syndrome complicated by ARF.Thirty-nine patients with pregnancy-related ARF were treated between Jan 1, 1989 and Jan 1, 1999. In these patients, the most frequent causes were HELLP syndrome (n = 14; 36%), postpartum hemorrhage (n = 10; 26%), pre-eclampsia/eclampsia (n = 6;15%) and abruptio placenta (n = 4;10%). Seven of the patients with HELLP syndrome had impairment of consciousness during hospitalization. Of these patients, coma in 5, stupor in 1, confusion in 1 were diagnosed. Twelve of the patients with HELLP syndrome and 14 of the other patients were treated by dialysis. Mann-Whitney U test and X2 test(corrected by Yates and Fisher exact) were used for statistical analysis.Although serious clinical findings, with supportive treatment, 12 patients with HELLP syndrome and 21 other patients were fully recovered. One patient both with and without HELLP syndrome could not recovered due to diffus cortical necrosis. Moreover, one patient with HELLP syndrome and 3 other patients were died. Mortality rate of the patients with HELLP syndrome was not found different from those of the other patients (p = 0.544). The causes of death were cerebral hemorrhage in patient with HELLP syndrome and disseminated intravascular coagulation (n = 1), cerebral emboli (n = 1), adult respiratory distress syndrome (n = 1). Fetal death occured in 4 patients with HELLP syndrome (28.5%) and 7 other patients (28%), and rates were similar(p > 0.5).Finally, HELLP syndrome was the most frequent cause leading to ARF in pregnancy and their prognosis was not different from those of the other patients.

Acute Renal Failure in Pregnancy

Between 1982 and 1992, 18 cases of pregnancy-related acute renal failure (PR-ARF) were observed (9% of the total number of ARF). Mean age of the women was 32 years (22-40 years). Uterine hemorrhage and preeclampsia/eclampsia were the major causes of ARF, accounting for 61% of the cases. Patchy renal cortical necrosis was suspected in 2 cases whereas signs of disseminated intravascular coagulation (DIC) or microangiopathic hemolytic anemia were present in 6 (33%) and 9 (50%) cases, respectively. Ten women required hemodialysis; and 6 of them, additional plasma exchange sessions. Five patients (28%) died during the acute phase of the illness, mainly due to brain damage, hepatic failure, and sepsis. Among the survivors, a complete (61.5%) or partial recovery (23.1%) was usually seen, but irreversible renal failure was recorded in 2 cases with postpartum hemolytic uremic syndrome (HUS). Short-lasting oligoanuria (< 3 days) represents a good prognostic index. However, the presence of vascular injury (cortical necrosis, HUS) seems to carry a poor prognosis. In conclusion, PR-ARF is still a critical occurrence, associated with serious prognosis for both women and kidneys. So far, the most effective measures remain the careful prevention and the aggressive management of the obstetric complications.

The role of intravascular coagulation in pregnancy related acute renal failure

Pregnancy-related acute renal failure (ARF) can include reversible tubular necrosis as well as irreversible cortical necrosis. Though pathogenetic mechanism are not fully understood, disseminated intravascular coagulation (DIC) probably plays a primary role. We report 25 cases of pregnancy-related ARF: 13 were associated with preeclampsia or eclampsia and 12 with obstetric complications. The following parameters were studied: partial thromboplastin, prothrombin and thrombin time, fibrinogen, anti-thrombin III and FDP levels, platelet count, whole blood clot lysis time and area, fragmented red cells (schistocytes) in the blood smear, hemoglobin, aptoglobin and LDH concentrations. DIC was scored in arbitrary units ranging from 12 to 36 and related to the clinical picture, renal outcome and the treatment employed. Five patients had irreversible renal damage, while 19 recovered fully; one patient died and no renal histology was available. The DIC score did not seem to have a significant relation to the severity of renal damage.

Postpartum acute renal failure in a drug addict

Renal diseases occur in intravenous drug abusers, especially heroin addicts, in the form of interstitial nephritis, nephrotic syndrome or acute renal failure due to rhabdomyolysis. We report a case of acute renal failure not ascribable to rhabdomyolysis nor to the main pathogenetic mechanisms of pregnancy-related acute renal failure in a pregnant heroin addict woman after vaginal delivery following uncomplicated pregnancy. Drug-related immunological abnormalities and microcirculatory distress may be involved.