Pregnancy-related acute renal failure in Eastern India

Abstract

Acute renal failure (ARF) in pregnancy constitutes 13.9% (76/545) of all the cases of ARF referred for dialysis in a period of ten years to the University Hospital, Banaras Hindu University, Varanasi, India. Fifty of these 76 pregnant women (66%) developed ARF after abortion and the remaining 26 (34%) had ARF due to complications of late pregnancy. The factors directly attributable to ARF are blood loss (51.3%), septicemia (28.9%), hypotension (34.2%), toxemia of pregnancy (13%), disseminated intravascular coagulation (23.6%), adult hemolytic uremic syndrome (9.2%), volume depletion (25%), and hemolysis (7.8%). The irreversible lesions of renal cortical necrosis was similar in early and late pregnancy. The overall incidence of diffuse renal cortical necrosis was 25%. Acute tubular necrosis was seen in 75% of cases, and histological evidence of disseminated intravascular coagulation was found in 16%. Maternal mortality was 33%. Bilateral renal cortical necrosis and septicemia were the major causes of death.