Spectrum and Short TermOutcome of Pregnancy relatedAcute Renal Failure among Women Admitted in Nephrology Ward; Pakistan Institute of Medical Sciences

Objective: To determine the clinical spectrum of pregnancy related acute renal failure (PR-ARF) and its outcome in terms of maternal and fetal morbidity and mortality. Study Design: Case series Place and duration: Department of Nephrology, Pakistan Institute of Medical Sciences, Islamabad from May 2009- April 2010. Materials and Methods: PR-ARF was diagnosed with sudden onset oligoanuria or serum creatinine elevated to above 1.5 mg% on two consecutive occasions . Patients with underlying CKD were excluded from the study. Results: 346 patients with acute renal failure were admitted in one year. 51 women fulfilled the criteria of PR-ARF. Frequency of PR-ARF was 51/346(14.7%). The clinical spectrum included 20/51(39.2%) cases of PIH/ PET / eclampsia with or without sepsis/DIC. 7/51(13.7%) had Acute tubular Necrosis (ATN), 10/51 (19.6%) had puerperal sepsis. 12/51(23.5%) had sepsis along with ATN, out of these 3 had septic abortion. RPGN 1/51 (1.9 %) and acute cortical necrosis 1/51 (1.9%) respectively. Pregnancy related ARF was seen mostly in third trimester/post partum in 46/51(90.2 %). It followed vaginal delivery in 32/51 (62.7%) patients and in 15/51 (29.4%) cases after cesarean section, and 3/51 (5.8%) patients after septic abortion with Dai handling. Dai (traditional birth attendant) handling was found in 17/51 (33.3 %).Antenatal care was not available to 39/51(76.4 %). Maternal outcome showed that 17/51 (33.3%) patients died 25/51 (49.0%) showed complete recovery, 2/51 (3.9%) had partial recovery, whereas irreversible renal failure in 4/51 (7.8 %). Outcome was unknown in 3/51(5.8 %). Conclusion Most common cause of pregnancy related acute renal failure is PIH associated with other risk factors like abruption, IUD, DIC and RPOC. Sepsis is the main contributory factor in PR-ARF. No antenatal care and Dai handling was seen in most of patients. Pregnancy related acute renal failure has a very high maternal mortality and morbidity.