title: Hospital outcomes of obstetrical-related acute renal failure in a tertiary care teaching hospital.
abstract: Management of obstetrical acute renal failure remains a challenging task. We present data of 100 cases of obstetrical -related acute renal failure of 3-year duration (2007-2009) from Department of Nephrology & Hypertension, Lady Reading Hospital, Peshawar, Pakistan. The study is aimed to look at overall mortality and relationship of oliguria/anuria at presentation to dialysis dependency and renal cortical necrosis (RCN). Evaluation of comorbidity to dialysis dependency and RCN was also considered. While 91 patients required hemodialysis, 9 were managed conservatively; 57 were dialysis dependent whereas 43 remained dialysis independent on discharge; 47 patients had oliguria, 30 had anuria, and 23 had an output of >800 mL per 24 h on admission. RCN was seen in 30 cases, all biopsy confirmed; among these, 26 cases (86.67%) were associated with oliguria/anuria and dialysis dependency right from the beginning (p < 0.0001). However, four (13.33%) with RCN had output >800 mL per 24 h but remained dialysis dependent. Our data showed that out of 30 patients who presented with anuria, only 10 patients (33.33%) were dialysis independent on discharge, whereas out of 47 oliguric patients, 21 patients (44.6%) were dialysis independent upon discharge. Thus dialysis dependency does not correlate with anuria or oliguria at presentation (p = 0.133). Mortality of 7% was recorded; 23% were discharged with normal renal function. Septicemia, operative interventions, retained product of conception, post-partum hemorrhage, and RCN remained important comorbid conditions with regard to survival and dialysis dependency.
authors.affiliation: Department of Nephrology & Hypertension, Post Graduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan. akhtaranjum@hotmail.com
authors.forename: Akhtar
authors.initials: A
authors.lastname: Ali
authors.forename: Mahrukh Ayesha
authors.initials: MA
authors.lastname: Ali
authors.forename: Mohammad Usman
authors.initials: MU
authors.lastname: Ali
authors.forename: Shad
authors.initials: S
authors.lastname: Mohammad
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000401:mortality* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D001002:Anuria / Q000453:epidemiology*; D015897:Comorbidity; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007672:Kidney Cortex / Q000473:pathology; D007673:Kidney Cortex Necrosis / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D009846:Oliguria / Q000453:epidemiology*; D010154:Pakistan / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D011644:Puerperal Disorders / Q000401:mortality* / Q000473:pathology; D006435:Renal Dialysis; D055815:Young Adult