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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2011  |  Volume : 22  |  Issue : 2  |  Page : 352-353
Pregnancy-related acute renal failure: A ten-year experience


Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

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Date of Web Publication18-Mar-2011
 

How to cite this article:
Sivakumar V, Sivaramakrishna G, Sainaresh V V, Sriramnaveen P, Kishore C K, Rani CS, Jagadeesh K. Pregnancy-related acute renal failure: A ten-year experience. Saudi J Kidney Dis Transpl 2011;22:352-3

How to cite this URL:
Sivakumar V, Sivaramakrishna G, Sainaresh V V, Sriramnaveen P, Kishore C K, Rani CS, Jagadeesh K. Pregnancy-related acute renal failure: A ten-year experience. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2017 May 22];22:352-3. Available from: http://www.sjkdt.org/text.asp?2011/22/2/352/77635
To the Editor,

Acute renal failure is a rare but important com計lication during pregnancy. The incidence of pregnancy-related acute renal failure (PRARF) in the developed countries is 1-2.8%, whereas in the developing countries this is about 4.2- 15%. [1],[2],[3] Renal failure in pregnancy has a bimo苓al distribution, one peak occurring during the 7 th and 8 th weeks of pregnancy and a second peak occurring during the 32 nd and 36 th weeks of pregnancy. [3] Based on the trimester of preg要ancy, PRARF is divided into three groups, viz. first half, second half and postpartum ARF. Septic abortion is the most common cause of ARF during the first half of preg要ancy; pre-eclampsia or abruptio placenta are the causes in the second half of pregnancy while hemolytic uremic syndrome occurs in the postpartum period. [1]

Of 1353 patients of acute renal failure admi負ted to the nephrology department of our insti負ute during 1999 to 2009, 59 patients (4.36%) were associated with pregnancy. The age range was 15-45 years, with a mean of 25.6 years. PRARF was seen in the postpartum period in 74.57%, in the third trimester in 16.94%, in the second trimester in 6.77% and in the first tri衫ester in 1.69%. It followed normal delivery in 30.50% and cesarean section in 33.89%. The laboratory findings and the causes are given in a tabular form [Table 1] and [Table 2]. Dialysis sup計ort (HD 49.15%, CVVHD 6.77% and PD 3.38%) was needed in 59.32%. There was complete recovery in 54.23%, partial recovery in 10.16% and death in 23.72%. Over 11.86% left against medical advice. The frequency of PRARF reported from several Indian studies varied between 15% and 4.3% [Table 3]. [1],[2],[3],[4],[5],[6] In our present study, it was about 4.36%. Sepsis was found to be the major cause in producing PRARF. However, it was due to septic abor負ions and puerperal sepsis in several studies. [3],[5],[6] In our patients, it was predominantly due to puerperal sepsis.
Table 1: Laboratory findings in patients with pregnancy-related acute renal failure.

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Table 2: Causes of pregnancy-related acute renal failure.

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Table 3: Prevalence of pregnancy-related acute renal failure in various studies.

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In conclusion, PRARF continues to be of sig要ificant occurrence, accounting for over 4.3% of the ARF in our study. Puerperal sepsis was the important cause (47.41%). Im provement in the care during the peripartum period will help in reducing PRARF.

 
   References Top

1.Goplani KR, Shah PR, Gera DN, et al. Preg要ancy related acute renal failure: A single center experience. Indian J Nephrol 2008;18 (1):17-21.  Back to cited text no. 1
    
2.Sunil Kumar K, Ramakrishna C, Sivakumar V. Pregnancy related acute renal failure. J Obstet Gynecol India 2006;56(4):308-10.  Back to cited text no. 2
    
3.Chugh KS. Etiopathogenesis of acute renal failure in the tropics. Ann Natl Acad Med Sci (India) 1987;23(2):88-99.  Back to cited text no. 3
    
4.Prakash J, Tripathi K, Malhotra V, et al. Acute renal failure in eastern India. Nephrol Dial Transplant 1995;10:2009-12.  Back to cited text no. 4
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5.Rani TU, Narayen G, Anuradha. Changing trends in pregnancy related acute renal failure. J Obstet Gynecol India 2002;52:36-8.  Back to cited text no. 5
    
6.Saleem Najar M, Rashid Shah A, Wani IA, et al. Pregnancy related acute kidney injury: A single center experience from the Kashmir valley. Indian J Nephrol 2008;18(4):159-61.  Back to cited text no. 6
    

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Correspondence Address:
V Sivakumar
Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh
India
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PMID: 21422644

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    Tables

  [Table 1], [Table 2], [Table 3]

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