ACUTE-RENAL-FAILURE IN PREGNANCY IN SOUTH-AFRICA

This study compares our experiences of the incidence and etiology of a cute venal failure in pregnancy (ARF-P) in patients requiring hemodial ysis, a decade after a previous publication from our institution. A re trospective analysis of the hospital records of 42 patients with a dia gnosis of ARF-P during a 3-year period from 1990 to 1992 was undertake n [16% of the total number of acute venal failure (ARF) patients needi ng hemodialysis]. The incidence of ARF-P (expressed relative to all ca ses of acute renal failure requiring hemodialysis) decreased from 24.6 % (1978) to 16% (1992: p = 0.03), Preeclampsia-eclampsia (PE:E) replac ed septic abortion as the principal cause of ARF-P. In those patients with PE:E, thrombocytopenia (platelet count < 150 x 10(9)/L) occurred in all, while 33% developed the HELLP syndrome (hemolysis, elevated li ver enzymes, and low platelets). Ingestion of herbal toxins was noted mostly in patients with septic abortion. Maternal mortality was 5% and was due to multiorgan failure complicating septic abortion. The perin atal mortality of 55% occurred in women with early gestation thrombocy topenia, and high serum creatinine levels. Acute renal failure in preg nancy continues to present a challenge in South Africa, a developing c ountry. There were significantly move obstetric than gynecological cau ses in 1992 (p = 0.0003). This could be attributed to the steady decli ne in septic abortion since 1978. The main contributor to obsretric-re lated causes was PE:E. Greater emphasis should therefore be placed on detecting hypertension at antenatal visits. Overall maternal