Acute renal failure in pregnancy in a developing country: twenty years of experience.
Acute renal failure (ARF) has become a rare complication of pregnancy in developed countries. The aim of this study was to describe changing trends in pregnancy-related acute renal failure (PR-ARF) in two successive periods; 1982-1991 and 1992-2002. From July 1982 to December 2002, 190 cases of PR-ARF were observed in Eastern India (11.6% of total number of ARF needing dialysis). Obstetrical complications were causative factors for ARF in 15% (65/426) and 10% (125/1201) of patients in the two periods, respectively. The incidence of PR-ARF fell from 15% in 1982-1991 to 10% in 1992-2002, with respect to the total number of acute renal failure cases. Post-abortal ARF showed a declining trend, 9% in the 1980s to 7% in the 2000s, of the total number of ARF cases. Preeclampsia-eclampsia was the cause of obstetrical ARF in 23% (1982-1991) and 14.4% (1992-2002) of cases in these two periods. The percentage of total ARF due to eclampsia declined from 3.5% during the period 1982-1991 to 1.4% in 1992-2002. Puerperal sepsis contributed to 0.8% of total ARF in recent years, compared to 2.4% in the earlier period. The incidence of cortical necrosis decreased significantly (p < 0.001) from 17% in 1982-1991 to 2.4% in the 2000s. The maternal mortality reduced to 6.4% in 1992-2002 from initial high mortality of 20% in the period of 1982-1991.


CONCLUSIONS
PR-ARF which remained high in the initial period has decreased in recent years. This is associated with a declining trend in
Prakash
Jai
J
Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India. jaiprakashbhu@hotmail.com
Kumar
Hemant
H
Sinha
D K
DK
Kedalaya
P G
PG
Pandey
L K
LK
Srivastava
P K
PK
Raja
R
R
Usha
D000028:Abortion, Induced / Q000706:statistics & numerical data; D000031:Abortion, Septic; D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D015994:Incidence; D007194:India / Q000453:epidemiology; D007673:Kidney Cortex Necrosis / Q000209:etiology; D007684:Kidney Tubules / Q000473:pathology; D008428:Maternal Mortality / Q000639:trends; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D011645:Puerperal Infection / Q000453:epidemiology*; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000150:complications / Q000453:epidemiology