Acute renal failure in pregnancy: one year observational study at Liaquat University Hospital, Hyderabad

To determine the incidence of pregnancy related acute renal failure (ARF), clinical spectrum, morbidity and mortality of this preventable complication of pregnancy.

An observational and prospective hospital based study was conducted at a tertiary care hospital in Hyderabad for one year from Nov. 2004-Oct. 2005. Total 116 patients of ARF were admitted in Nephro-Urology ward during this period of whom 42 were of obstetric related ARF and they were included in the study. A pre-designed proforma was used. The clinical history was noted and all underwent a physical examination. Urine output was recorded. Routine laboratory tests were performed and specialized tests as DTPA scan was done in some cases. The final outcome was recorded. The majority i.e. 31 patients were from village community of interior Sindh province and the remaining 11 were from Hyderabad city area.

Pregnancy related ARF numbered 42 (36%) of which 28 (67%) were multipara and 14 (33%) were primigravida. Their ages were between 20 to 41 years. Majority 24 (57%) patients had not received any antenatal care and there was a history of traditional birth attendants TBA (Dai) assisted home delivery as compared to 6 (14%) cases with adequate antennal care. Six (14%) cases presented in their first trimester of pregnancy while 36 (86%) patients developed ARF in their 3rd. trimester or in the puerperium and 19 (45%) were anuric. Blood loss causing hypotension due to APH and PPH was the common cause of ARF. Clinical spectrum of pregnancy related ARF showed APH in 6 (14%) cases, PPH in 9 (24%) cases, septic abortion and puerperal sepsis and DIC in 13 (31%) cases, IUD in 6 (14%) and preeclampsia / eclampsia in 5 (12%) cases. Thirty (71%) patients received haemodialysis and 12 (29%) did not require dialysis. Commonest clinical diagnosis was ATN in 23 (55%) cases with complete recovery. Acute bilateral renal cortical necrosis was seen in 9 (21%) cases and 2 (5%) patients had patchy cortical necrosis. Overall morbidity was 19% and mortality 26%.

Pregnancy related acute renal failure is a major health, problem especially in the villages of Sindh provinces and carries very high mortality and morbidity. Poor healthcare facilities and lack of antenatal healthcare clinics are major identified causes.