title: Renal cortical necrosis is a disappearing entity in obstetric acute kidney injury in developing countries: our three decade of experience from India.
abstract: BACKGROUND
  Obstetrical complications are the commonest causes of Renal Cortical Necrosis (RCN). However, the overall incidence of RCN in obstetric acute kidney injury in developing countries has been decreasing in recent years.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the changing profile of RCN in obstetric AKI over the last three decades.
  
  
  METHODS
  This single center study included patients with biopsy proven renal cortical necrosis over a period of 32 years from 1982 to 2014. The diagnosis of RCN was suspected in patients with prolonged AKI (>4 weeks) with absolute anuria in the setting of hemorrhage, hypotension and sepsis; and was confirmed by renal biopsy. The changing pattern in the incidence, etiology and outcome of RCN in patients with obstetric AKI was compared in the three study periods, namely 1982-1991, 1992-2002 and 2003-2014.
  
  
  RESULTS
  Over a period of 32 years, RCN was diagnosed in 15/259(5.8%) cases of obstetric AKI. Diffuse and patchy cortical necrosis were noted in 8(53.3%) and 7(46.7%) patients, respectively. RCN occurred in 17%(11/65), 2.4%(3/125) and 1.44%(1/69) patients in 1982-1991, 1992-2002 and 2003-2014, respectively. Septic abortion was commonest cause of RCN in the first two study periods but no case was observed in last decade. The decrease in incidence of RCN over the three decades was statistically significant (p-value < 0.001). Maternal mortality decreased to zero in 2003-2014 from 72.7% in 1982-1991.
  
  
  CONCLUSIONS
  The incidence of RCN in obstetric AKI in developing countries has declined low enough to label it as a disappearing entity.
authors.affiliation: a Department of Nephrology , Institute of Medical Sciences, Banaras Hindu University , Varanasi , Uttar Pradesh , India and.
authors.forename: Jai
authors.initials: J
authors.lastname: Prakash
authors.affiliation: a Department of Nephrology , Institute of Medical Sciences, Banaras Hindu University , Varanasi , Uttar Pradesh , India and.
authors.forename: Pragya
authors.initials: P
authors.lastname: Pant
authors.affiliation: a Department of Nephrology , Institute of Medical Sciences, Banaras Hindu University , Varanasi , Uttar Pradesh , India and.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Singh
authors.affiliation: a Department of Nephrology , Institute of Medical Sciences, Banaras Hindu University , Varanasi , Uttar Pradesh , India and.
authors.forename: Shashidhar
authors.initials: S
authors.lastname: Sriniwas
authors.affiliation: a Department of Nephrology , Institute of Medical Sciences, Banaras Hindu University , Varanasi , Uttar Pradesh , India and.
authors.forename: Vijay P
authors.initials: VP
authors.lastname: Singh
authors.affiliation: b Department of Pathology , Institute of Medical Sciences, Banaras Hindu University , Varanasi , Uttar Pradesh , India.
authors.forename: Usha
authors.initials: U
authors.lastname: Singh
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D001002:Anuria; D001706:Biopsy; D003906:Developing Countries; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007673:Kidney Cortex Necrosis / Q000209:etiology / Q000401:mortality* / Q000473:pathology*; D008875:Middle Aged; D018743:Perinatal Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000145:classification*; D055815:Young Adult
keywords: Abruptio placentae; obstetric AKI; puerperal sepsis; renal cortical necrosis; septic abortion