Browsing by Author "Shashidhar Shree Niwas"

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Acute kidney injury in late pregnancy in developing countries
(2010) Jai Prakash; Shashidhar Shree Niwas; Aashish Parekh; Laxmi Kant Pandey; Loukrakpam Sharatchandra; Puneet Arora; Amit Kumar Mahapatra
Introduction: The data directly evaluating acute renal failure (ARF) in third trimester of pregnancy from Indian subcontinent are scanty. This study analyzes the clinical spectrum of ARF with respect to total birth in third trimester of pregnancy. Material: All pregnant women after the 28th week of pregnancy or in early postpartum period (up to 7 days) admitted to our hospital between August 2006 and August 2008 were screened for clinical evidence of ARF. Pregnant women with clinical diagnosis of ARF in third trimester were included in this study. Results: Of the 4758 pregnant women in third trimester, ARF developed in 85 cases (1 in 56 births). Preeclampsia, puerperal sepsis, and intrauterine death were responsible for ARF in 35.29, 24.7, and 16.67 of cases, respectively. Postpartum hemorrhage and antepartum hemorrhage were the causes of ARF in 10.59 and 8.29 of patients, respectively. Acute fatty liver of pregnancy was noted in one patient. Complicated preeclampsia (hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, eclampsia, and uterine hemorrhage) was associated and higher incidence of ARF. Live birth occurred in 61.2 of patients with vaginal delivery in 70 cases. Renal cortical necrosis was diagnosed in two cases. Overall, mortality was 20. The puerperal sepsis contributed 41 of total death. Conclusion: ARF complicated 1.78 of total delivery in third trimester of pregnancy. Preeclampsia was the most common cause of ARF followed by puerperal sepsis. In contrast to the developed countries, incidence of ARF is still very high in late pregnancy in the developing countries. Overall mortality was 20 with highest (33) mortality in puerperal sepsis group. © 2010 Informa UK, Ltd.
Spectrum of kidney diseases in patients with preeclampsia-eclampsia
(2010) Jai Prakash; Rubina Vohra; L.K. Pandey; Shashidhar Shree Niwas; S.K. Behura; Usha Singh
Aim: The aim of this study was to analyse the clinical spectrum of renal manifestation of preeclampsia in pregnant women. Method: Diagnosis of preeclampsia was made using two cardinal feature of the disease after 20th weeks of gestation in previously normotensive and nonproteinuric women: (1) Blood pressure >140/90 mm Hg and (2) urinary protein excretion of > 300 mg/24 hour. The patients with renal manifestations were followed upto 12 weeks postpartum or till death whichever was earlier. Result: Of 1805 pregnant women, preeclampsia was diagnosed in 106 (5.87%) patients. Primiparity constitutes 53.77% of total patients. Hypertension and proteinuria were observed in all patients. Hyperuricemia was observed in 93.65% of cases. Acute renal failure occurred in 22 patients. Dialysis support was needed in only four cases of ARF with complete recovery of renal function in 82% of cases. HELLP syndrome was seen in 16 (preeclampsia 5; eclampsia 11) patients. Sixty six patients (Death 13 and lost to follow up 27) were followed for 12 weeks. The renal parameters (Hypertension, Proteinuria and renal function) returned to normal in all except in two patients. Renal biopsy in these two cases rev ealed FSGS and MPGN in one each. Conclusion: The incidence of preeclampsia was 5.87%. Nephrotic syndrome was observed in 11.32% of patients. Acute renal failure occurred in 20.8% of patients. Hypertension, proteinuria and renal function resolved to normal over a average period of 35.8 days in all survivors. The overall mortality was 12%. Neurological complication, pulmonary edema and multiple organ failure were the causes of death. © JAPI.