Acute renal failure in pregnancy in South Africa.
This study compares our experiences of the incidence and etiology of acute renal failure in pregnancy (ARF-P) in patients requiring hemodialysis, a decade after a previous publication from our institution. A retrospective analysis of the hospital records of 42 patients with a diagnosis of ARF-P during a 3-year period from 1990 to 1992 was undertaken [16% of the total number of acute renal failure (ARF) patients needing hemodialysis]. The incidence of ARF-P (expressed relative to all cases of acute renal failure requiring hemodialysis) decreased from 24.6% (1978) to 16% (1992: p = 0.03). Preeclampsia-eclampsia (PE:E) replaced septic abortion as the principal cause of ARF-P. In those patients with PE:E, thrombocytopenia (platelet count < 150 x 10(9)/L) occurred in all, while 33% developed the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Ingestion of herbal toxins was noted mostly in patients with septic abortion. Maternal mortality was 5% and was due to multiorgan failure complicating septic abortion. The perinatal mortality of 55% occurred in women with early gestation, thrombocytopenia, and high serum creatinine levels. Acute renal failure in pregnancy continues to present a challenge in South Africa, a developing country. There were significantly more obstetric than gynecological causes in 1992 (p = 0.0003). This could be attributed to the steady decline in septic abortion since 1978. The main contributor to obstetric-related causes was PE:E. Greater emphasis should therefore be placed on detecting hypertension at antenatal visits.(ABSTRACT TRUNCATED AT 250 WORDS)
Randeree
I G
IG
Department of Medicine, University of Natal, Durban, Republic of South Africa.
Czarnocki
A
A
Moodley
J
J
Seedat
Y K
YK
Naiker
I P
IP
D000031:Abortion, Septic / Q000150:complications; D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D000328:Adult; D003906:Developing Countries; D005260:Female; D006801:Humans; D015994:Incidence; D008428:Maternal Mortality; D011225:Pre-Eclampsia / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology