Acute kidney injury in late pregnancy in developing countries

The data directly evaluating acute renal failure (ARF) in third trimester of pregnancy from Indian subcontinent are scanty. This study analyzes the clinical spectrum of ARF with respect to total birth in third trimester of pregnancy.

All pregnant women after the 28th week of pregnancy or in early postpartum period (up to 7 days) admitted to our hospital between August 2006 and August 2008 were screened for clinical evidence of ARF. Pregnant women with clinical diagnosis of ARF in third trimester were included in this study.

Of the 4758 pregnant women in third trimester, ARF developed in 85 cases (1 in 56 births). Preeclampsia, puerperal sepsis, and intrauterine death were responsible for ARF in 35.29, 24.7, and 16.67% of cases, respectively. Postpartum hemorrhage and antepartum hemorrhage were the causes of ARF in 10.59 and 8.29% of patients, respectively. Acute fatty liver of pregnancy was noted in one patient. Complicated preeclampsia (hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, eclampsia, and uterine hemorrhage) was associated and higher incidence of ARF. Live birth occurred in 61.2% of patients with vaginal delivery in 70% cases. Renal cortical necrosis was diagnosed in two cases. Overall, mortality was 20%. The puerperal sepsis contributed 41% of total death.

ARF complicated 1.78% of total delivery in third trimester of pregnancy. Preeclampsia was the most common cause of ARF followed by puerperal sepsis. In contrast to the developed countries, incidence of ARF is still very high in late pregnancy in the developing countries. Overall mortality was 20% with highest (33%) mortality in puerperal sepsis group.