ACUTE-RENAL-FAILURE IN PREGNANCY

Between 1982 and 1992, 18 cases of pregnancy-related acute renal failu re (PR-ARF) were observed (9% of the total number of ARF). Mean age of the women was 32 years (22-40 years). Uterine hemorrhage and preeclam psia/eclampsia were the major causes of ARF, accounting for 61% of the cases. Patchy renal cortical necrosis was suspected in 2 cases wherea s signs of disseminated intravascular coagulation (DIC) or microangiop athic hemolytic anemia were present in 6 (33%) and 9 (50%) cases, resp ectively. Ten women required hemodialysis; and 6 of them, additional p lasma exchange sessions. Five patients (28%) died during the acute pha se of the illness, mainly due to brain damage, hepatic failure, and se psis. Among the survivors, a complete (61.5%) or partial recovery (23. 1%) was usually seen, but irreversible renal failure was recorded in 2 cases with postpartum hemolytic uremic syndrome (HUS). Short-lasting oligoanuria (< 3 days) represents a good prognostic index. However, th e presence of vascular injury (cortical necrosis, HUS) seems to carry a poor prognosis. In conclusion, PR-ARF is still a critical occurrence , associated with serious prognosis for both women and kidneys. So far , the most effective measures remain the careful prevention and the ag gressive management of the obstetric complications.