OBSTETRICAL ACUTE RENAL FAILURE FROM FRONTIER PROVINCE: A 3 YEARS PROSPECTIVE STUDY

Objective: To evaluate the etiology, complications, causes of death, fetal outcome, management strategies and prognosis of the patients with obstetrical acute renal failure.Material and Methods: This is a prospective 3 years study at a tertiary care hospital of patients suffering from acute renal failure of obstetrical origin at Department of Nephrology, Lady Reading Hospital, Peshawar from 1998 to 2000. The patients were folio wed-up 1 year as an outpatient following hospital discharge.Results: Acute Renal Failure (ARF) constitute 16-20% of our total admissions out of which obstetrical ARF amounts from 07-10%. Postpartum Hemorrhage (PPH) constituting 35%, septicemia 24%, combine Antepartum Hemorrhage (APH) PPH with eclampesia 20%, APH (pure) 08%, severe eclampesia 03%. The mean age was 29.6 years, which 55% multiparas and 45% grand multiparous. 25% of the patients had the major surgical procedures either caesarian section (C-sec) or hysterectomy. 06% had septic abortion. 62% have normal vaginal delivery. 62% required hemodialysis (HD), 14% were offered peritoneal dialysis (PD), 03% received both, 21% were managed conservatively. The overall mortality was 18%.Conclusion: Obstetrical acute renal failure has high mortality. Itʹs a common cause of morbidity and mortality. In addition to Acute Tubular Necrosis (ATN) as a leading cause of reversible ARF, cortical necrosis contribute significantly to the permanent loss kidney functions and adds to co-morbidity2.