Outcomes of Pregnancy related acute renal failure

Objectives: To study the outcome of pregnancy related acute renal failure. Patients and Methods: This observational interventional study was conducted in Nephrology unit, DHQ Hospital, Gomal Medical College, Dera Ismail Khan from April, 2004 to April, 2007. It included 88 pregnant women with established renal failure. Results: Mean age of the patients was 28.5 years. Sixty-five (73.86%) patients had developed renal failure in late and 23(26.14%) in early pregnancy. Sixty-eight (77.28%) were multiparous and 20 (22.72%) were primigravida. Seventy-one (80.68%) women did not receive any form of antenatal care at any stage of pregnancy. A total of 73 (82.96%) patients were oligoanuric and 15 (17.04%) were non-oliguric but all had well established acute tubular necrosis (ATN) secondary to hypotension due to loss of blood, volume depletion or sepsis. Complete renal recovery was observed in 77 (87.5 %) patients, out of whom 13 (14.72%) recovered without dialysis support. Eleven patients (12.5%) developed irreversible renal dysfunction. Mean hospital stay was 27.6 days. Mortality was 12.5%, mostly due to sepsis, DIC and multiorgan failure. Those who survived were reevaluated after one year and 87.5% were alive. Conclusion: Pregnancy related acute renal failure is a critical condition, associated with serious prognosis for both women and kidneys. So far, the most effective measures still remain the careful prevention and the aggressive management of the obstetric complications. 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 specialities. (Rawal Med J 2008;33:189-192).