Syed Liaquat Ali Khan.
Acute renal failure in pregnancy: one year observational study at nephrology department Sandeman Provincial Hospital Quetta.
Pak J Med Health Sci Jan ;4(3):188-91.

Objective: To determine the incidence of pregnancy related acute renal failure, clinical spectrum, mortality and morbidity of this preventable complication of pregnancy. Methods: An observational and prospective hospital based study was conducted at a territory care hospital in Quetta for one year from July 2008 to June 2009 .Total 140 patients of ARF were admitted in nephrology ward during this specific period of whom 54 were of obstetrical related ARF and they were included in the study . A predesigned proforma was used. The clinical history was noted and all under went a clinical examination .The vitals and urine out put was recorded regularly .Routine laboratory tests were performed and specialized test as DTPA scan, D dimers were done in some cases .The final out come was recorded . The majority of 32 patients were from rural area of Balochistan province, neighbour country Afghanistan and the remaining 22 were from Quetta, Pashine and Mustung Cities. Results: Obstetrical related acute renal failure number 54 (39%) of which 30 (56%) were multipara and 24(44%) were primigravida. Their ages were between 18-42 years. Majority 32(59%) patients had not received any antenatal care and there was a history of traditional birth attendants assisted home delivery as compared to 7(13%) cases with adequate ante natal 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 causing hypotension due to postpartum hemorrhage and ante-partum hemorrhage was the commonest cause of acute renal failure. Clinical spectrum of pregnancy related acute renal failure showed ante-partum hemorrhage in 11(20%) cases, postpartum hemorrhage 14(25%) cases, puerperal sepsis and septic abortion and disseminated intravascular coagulation in 18(33%) cases, intrauterine disease 7(13%) and pre-eclamsia, eclampsia, hemolysis, elevated liver enzyme, low platelets syndrome in 4 (7%) cases. 44 (81%) patients received hemodialysis and 10(19%) did not require hemodialysis. Commonest clinical diagnosis was acute tubular necrosis in 33(61%) cases with complete recovery. Acute renal cortical necrosis was seen in 11 (22%) cases. Conclusion: Pregnancy related acute renal failure is a major health problem especially in the rural areas of Balochistan province, neighbor country Afghanistan and carries very high mortality and morbidity. Lack of antenatal health care clinics, poor health facilities and late referrals are major identified causes.

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