Short and long term results of Acute Renal Failure related to complications of Pregnancy

Introduction: The co-existance of pregnancy and renal disease is a serious risk factor either for the mother and the fetus. This risk leads the doctors to stop or prevent the pregnancy but this is a very pessimistic approach. In this study we investigated the etiological, clinical and bio-chemistrical parameters and the residual renal functions after 6 months of our patients with high maternal-fetal morbidity and mortality ratios due to obstetrical acute renal failure and compared the results with the literature.Material and Method: In the study, 50 patients (32.4+5.7 years old) from the gynecology clinic, who diagnosed acute renal failure between January 2006 and August 2007 in their pregnancy, postabortal, and postpartum period were investigated prospectively. the following criteria was used for the diagnose of acute renal failure: oliguria or anuria + creatinine clearance <20 ml/min+ plasma creatinine >2mg/dlt. The patients who diagnosed chronic renal failure previously were not included to the study.Results: The 50 % of patients was with preeclampsia-HELLP (PH), 12% eclampsia-HELLP (EH), 6% preeclampsia, 18% infection, 8% hemorrhage, 4% AFLP and 2% TTP. Maternal death rate was 12%. The maternal complications were as followed: 10% DIC, 22% ablasio placenta, 4% intracerebral hemorrhage and 18% respiratory distress. Also we needed to transfused blood or blood products in 72% of the patients, and 18% of them needed mechanic ventilation. Besides the common complications, delirium was diagnosed in one patient and coronary artery dissection was occurred in another one. From the point of view of perinatal morbidity and mortality: the intrauterine death rate was 32%, abortus was 12%, prematurity was 6% and the ratio of babies who survived was 56% including the premature ones. In our follow up, 4 patients remained with chronic renal failure, one undergo the maintenance hemodialysis and 3 of them survived as moderate chronic kidney disease. On the other hand blood pressure did not normalized and anti-hypertensive treatment needed for 2 patients.Conclusion: Obstetrical acute renal failure is maintaining its importance in our study population, because of the fetal or maternal mortality and morbidity rates. We must increase the number of preventive medicine measures and the number of prenatal-antenatal care units in consideration of socioeconomic state of our study population.Key words: Obstetric, acute renal failure, pre-eclampsia, HELLP