title: Renal Cortical Necrosis in Postpartum Hemorrhage: A Case Series.
abstract: Pregnancy-related renal cortical necrosis may lead to end-stage renal disease. Although this obstetric complication had virtually disappeared in high-income countries, we have noted new cases in France over the past few years, all following postpartum hemorrhage.
  
  
  
  Case series.
  
  
  
  We retrospectively identified 18 patients from 5 French nephrology departments who developed renal cortical necrosis following postpartum hemorrhage in 2009 to 2013.
  
  
  
  Obstetric and renal features, therapeutic measures, and kidney disease outcome were studied.
  
  
  
  All patients had a severe postpartum hemorrhage (mean blood loss, 2.6±1.1 [SD] L). Hemodynamic instability and disseminated intravascular coagulation were reported in 5 and 11 patients, respectively. All developed rapid onset of acute kidney injury and required hemodialysis. Diagnosis of renal cortical necrosis was performed 4 to 33 days following delivery. At 6 months postpartum, 8 patients remained dialysis dependent and none recovered normal kidney function. The length of exposure to tranexamic acid treatment was significantly more prolonged in women whose estimated glomerular filtration rate remained <15mL/min/1.73m(2) (7.1±4.8 vs 2.9±2.4 hours; P=0.03).
  
  
  
  Retrospective study; small sample size.
  
  
  
  In the setting of gravid endothelium, the conjunction of disseminated intravascular coagulation with the life-saving use of procoagulant and antifibrinolytic agents (recently implemented in France in a postpartum hemorrhage treatment algorithm) may give rise to a risk for uncontrolled clotting in the renal cortex and hence irreversible partial or diffuse cortical necrosis.
authors.affiliation: Service de Néphrologie, Hôpital Claude Huriez, CHU Lille, Université de Lille, Lille, France. Electronic address: marie.frimat@chru-lille.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Frimat
authors.affiliation: Service de Néphrologie, Hôpital Victor Provo, Roubaix, France.
authors.forename: Melanie
authors.initials: M
authors.lastname: Decambron
authors.affiliation: Service de Néphrologie, CH Valenciennes, Valenciennes, France.
authors.forename: Celine
authors.initials: C
authors.lastname: Lebas
authors.affiliation: Service d'Anatomie Pathologique, APHP, Hôpital Tenon, Paris, France.
authors.forename: Anissa
authors.initials: A
authors.lastname: Moktefi
authors.affiliation: Service de Radiologie, Hôpital Claude Huriez, CHU Lille, Université de Lille, Lille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Lemaitre
authors.affiliation: Centre de Biologie et Pathologie, CHU Lille, Université de Lille, Lille, France.
authors.forename: Viviane
authors.initials: V
authors.lastname: Gnemmi
authors.affiliation: Service de Néphrologie, CHU Tours, Tours, France.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Sautenet
authors.affiliation: Service de Néphrologie, Hôpital Claude Huriez, CHU Lille, Université de Lille, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Glowacki
authors.affiliation: Pôle Femme Mère Nouveau-Né, Hôpital Jeanne de Flandre, EA 2694, PRES Université Lille Nord de France, Lille, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Subtil
authors.affiliation: Pôle de Réanimation, CHU Lille, Université de Lille, Lille, France.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Jourdain
authors.affiliation: Anesthésie-Réanimation, APHP, Hôpital Trousseau, Paris, France.
authors.forename: Agnes
authors.initials: A
authors.lastname: Rigouzzo
authors.affiliation: Service d'Anatomie Pathologique, APHP, Hôpital Tenon, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Brocheriou
authors.affiliation: Service de Néphrologie, CHU Tours, Tours, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Halimi
authors.affiliation: APHP, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Rondeau
authors.affiliation: Service de Néphrologie, Hôpital Claude Huriez, CHU Lille, Université de Lille, Lille, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Noel
authors.affiliation: Service de Néphrologie, Hôpital Claude Huriez, CHU Lille, Université de Lille, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Provôt
authors.affiliation: APHP, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Hertig
mesh_terms: D000328:Adult; D005260:Female; D005602:France; D006801:Humans; D007673:Kidney Cortex Necrosis / Q000209:etiology*; D006473:Postpartum Hemorrhage; D012189:Retrospective Studies
keywords: France; Renal cortical necrosis; TXA dosage; acute kidney injury (AKI); antifibrinolytic; end-stage renal disease (ESRD); obstetric complication; postpartum hemorrhage; pregnancy; tranexamic acid (TXA)