Dr Hafiza Ezza Tariq, Dr Mahnoor Zafar Siddiqi, Dr Narmeen Qureshi
Aim: To determine the incidence of acute pregnancy-related renal failure, clinical spectrum, mortality and morbidity of this avoidable pregnancy complication. Study Design: An observational and prospective hospital-based study. Place and Duration: In the Nephrology department in collaboration with obstetrics and gynecology department of Jinnah Hospital Lahore for one-year duration from January 2019 to January 2020. Methods: A total of 140 patients with ARI were admitted to the nephrology department. 54 of them are specific to the obstetric ARF and was included in the study. A predesigned proforma was used. Medical history has been recorded and all have been clinically examined. Vital signs and urine output were regularly recorded. Special tests were performed, such as routine laboratory tests and DTPA testing, in some cases D-dimers were performed. The final result has been registered. Most of the 32 patients were from rural areas. Results: Obstetrical related acute renal failure number 54 (39%) of which 30 (56%) were multipara and 24(44%) were primigravida. They were between 18 and 42 years old. Most 32 patients (59%) did not receive prenatal care. In the past, traditional midwives gave birth at home compared to 7 (13%) cases with adequate prenatal care. 9(17%) cases presented in their first trimester of pregnancy while 45(83%) patients developed acute renal failure in their third trimester or in the puerperium 20(37%) were anuric. Blood loss that caused hypotension due to postpartum and antenatal bleeding was the most common cause of acute renal failure. The clinical spectrum of acute renal failure due to pregnancy showed antenatal hemorrhage in 11 (20%) cases, postpartum hemorrhage in 14 (25%) cases, postpartum septicemia and septic abortion, and extensive intravascular thrombosis in 18 (33%) cases, intrauterine disease 7 ( 13%) and preeclampsia, eclampsia, hemolysis, high levels of liver enzymes, low platelet count in 4 (7%) cases. 44 (81%) patients underwent hemodialysis and 10 (19%) did not require hemodialysis. The most common clinical diagnosis was acute tubular necrosis in 33 (61%) patients with complete recovery. Acute necrosis of the renal cortex was observed in 11 (22%) cases. Conclusion: Acute renal failure due to pregnancy is an important health problem in rural areas and has very high mortality and morbidity. The lack of reasons is the lack of antenatal clinics, poor health care and late referrals. Keywords: acute renal failure, antenatal bleeding, hemodialysis.