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Acute renal failure in pregnancy.

N Pertuiset, J P Grunfeld

    Bailliere'S Clinical Obstetrics and Gynaecology
    |December 1, 1987
    PubMed
    Summary

    Acute renal failure in pregnancy is now rare due to improved prenatal care and reduced septic abortions. Management involves dialysis, blood pressure control, and specific therapies for severe cases like acute fatty liver.

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    Area of Science:

    • Nephrology
    • Obstetrics & Gynecology
    • Critical Care Medicine

    Background:

    • Acute renal failure (ARF) in pregnancy is a rare but serious complication.
    • Improvements in prenatal care, reduced septic abortions, and better management of conditions like pre-eclampsia have decreased ARF incidence.
    • Conditions such as acute fatty liver of pregnancy and idiopathic postpartum renal failure remain significant causes of ARF, carrying high morbidity and mortality.

    Purpose of the Study:

    • To review the current status and management of acute renal failure in pregnancy.
    • To highlight the importance of early diagnosis and intervention for maternal and fetal outcomes.
    • To discuss various treatment modalities, including dialysis and specific therapies.

    Main Methods:

    • Review of literature on acute renal failure in pregnancy.
    • Discussion of etiological factors, clinical presentation, and management strategies.
    • Emphasis on the role of supportive care and advanced treatment options.

    Main Results:

    • Septic abortion-related ARF has virtually disappeared.
    • Improved prenatal care has reduced ARF from volume contraction and other maternal complications.
    • Acute fatty liver and idiopathic postpartum renal failure are key complications requiring prompt management.
    • Dialysis (hemo- or peritoneal) is a crucial supportive therapy, with early prophylactic dialysis recommended.
    • Antihypertensives, blood transfusions, plasma infusion/exchange, and antiplatelet drugs may be beneficial.

    Conclusions:

    • Acute renal failure in pregnancy, while rare, necessitates prompt recognition and management.
    • Multifaceted treatment approaches, including dialysis and specific therapies, are vital for improving outcomes.
    • Continuous monitoring of fluid balance and anticoagulation is essential during dialysis in pregnant patients.

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