RT Book, Section
A1 Asrat, Tamerou
A1 Nageotte, Michael P.
A2 Foley, Michael R.
A2 Strong, Jr., Thomas H.
A2 Garite, Thomas J.
SR Print(0)
ID 1115790901
T1 Acute Renal Failure in Pregnancy
T2 Obstetric Intensive Care Manual, 4e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071820134
LK obgyn.mhmedical.com/content.aspx?aid=1115790901
RD 2024/04/19
AB Acute  renal  failure  (ARF)  can  present  in  multiple  complicated  medical  conditions  but  is  predominantly  acquired  in  hospitalized  patients.  This  is  not  a  rare  medical  condition,  with  as  many  as  5%  of  all  hospitalized  patients  having  some  degree  of  ARF.  With  respect  to  the  obstetric  patient,  however,  ARF  has  become  an  uncommon  complication  of  pregnancy  in  developed  countries.  It  is  estimated  that  the  current  incidence  of  ARF  complicating  pregnancy  approximates  1  per  10,000  pregnant  women.  In  3  successive  periods  of  10  years  between  1958  and  1987,  Stratta  and  colleagues  have  reported  a  continued  decrease  in  ARF  requiring  emergency  renal  dialysis  from  a  rate  of  1  in  3000  in  1958  to  1  in  15,000  pregnancies  in  1987.  They  documented  81  cases  of  ARF  in  pregnancy  of  which  11.6%  experienced  irreversible  renal  damage.  The  majority  of  these  cases  resulted  from  complications  of  either  severe  preeclampsia  or  eclampsia.  Possible  explanations  for  this  dramatic  trend  in  this  subset  of  patients  includes  ready  availability  of  prenatal  care  and  the  legalization  of  medical  abortions  as  main  factors  responsible  for  this  reduction  in  the  incidence  of  ARF  requiring  dialytic  support.  However,  in  underdeveloped  countries  of  the  world,  ARF  remains  a  frequent  complication  of  pregnancy  and  has  an  attendant  maternal  mortality  surpassing  50%.  In  these  countries,  ARF  has  a  bimodal  distribution  with  peaks  in  the  first  and  third  trimester,  presumably  reflective  of  the  continued  practice  of  illegal  abortions,  the  lack  of  access  to  quality  prenatal  care,  and  the  occurrence  of  preeclampsia  or  eclampsia.  Whatever  the  explanation,  ARF  in  pregnancy  can  be  the  result  of  any  of  the  disorders,  which  lead  to  severe  renal  dysfunction  in  nonpregnant  patients  or  may  result  from  disorders  that  are  unique  to  the  pregnant  condition.