Pregnancy-related acute renal failure in eastern India

ObjectiveTo study the causes, burden, and impact of pregnancy-related acute renal failure (PRARF) in a low-resource setting.MethodsA prospective observational study of consecutive women admitted to the Seth Sukhlal Karnani Memorial Hospital, Kolkata, India, with PRARF between February 1, 2007, and May 31, 2009, was conducted. The information collected included causes and predisposing conditions leading to PRARF, clinical presentations, medical and obstetric management—including need for dialysis—and maternal outcome.ResultsThe leading causes of PRARF among the 57 participants were sepsis 19 (33.3%), hemorrhage 16 (28.1%), and hypertensive disorders 15 (26.3%). The condition occurred in 11 (19.3%) cases before 20 weeks of gestation, 6 (10.5%) cases after 20 weeks of gestation, and 40 (70.2%) cases during puerperium. Most women were from rural areas and received inadequate prenatal care. Although 40 women had PRARF during puerperium, the precipitating event mostly started during the process of labor/delivery. Despite multidisciplinary care, mortality was high (28.1%); cause-specific fatality was highest with sepsis (36.8%) and hemorrhage (25.0%). Many women who survived experienced prolonged morbidity.ConclusionsPregnancy-related acute renal failure is potentially fatal but largely preventable. Universal prenatal care and greater access to emergency obstetric services, especially in rural India, could avert PRARF and its consequences.