MP189 ACUTE RENAL FAILURE IN PREGNANCY IN DEVELOPING COUNTRIES

Abstract

INTRODUCTION AND AIMS: Acute renal failure (ARF) in pregnancy is now a rare entity in the developed countries but still a common occurrence in developing countries. Delay in the diagnosis and late referral is associated with increased maternal ant fetal mortality. It remains common and costly in developing countries. The aim of this study is to describe the epidemiology, etiology and prognosis of ARF in pregnancy. METHODS: A retrospective study conducted between January 2006 and December 2016 in our department of nephrology, hospital Hedi Chaker, Sfax, Tunisia. Were included patients admitted to our department with gestational ARF. Patients with end stage renal disease (ESRD) were excluded. Clinical, obstetric, medical treatment and results were studied. RESULTS: We identified 19 cases. 84% received antennal care. The average age was 34 ± 4.4 years. Hemorrhage shock was showed in 10, 52 %, icterus in 3, 57%, eclampsia in 5, 26 % of cases. Hypertensive disorder of pregnancy was observed in 52, 63% of cases and anuria was present in 15.78% of patients. The median rate of creatinine was 350.3μmol/l (161-988μmol/l). Severe anemia (hemoglobin < 6g/dl) was observed in 10, 52% of cases. Hyperuricemia was observed in 47, 36% of cases. Hepatic cytolysis was showed in 26, 31% of cases. The etiologies of ARF in pregnancy were dominated by acute tubular necrosis in 42.10% of cases, thrombotic microangiopathy in 15, 78% of cases, retro placental hematoma in 10, and 52% of cases. Hemorrhagic shock was noted in 10, 52 % of cases. Renal biopsy was performed in 52.63% of cases, finding acute tubular necrosis in 26, 31 %, a thrombotic microangiopathy in 10, 52%, crescentic glomerulonephritis type III in 15,79 %, both acute tubular necrosis and cortical necrosis in 10,52% and both acute tubular necrosis with diabetic nephropathy in 10,52 % of cases. Recourse to extra renal therapy in the form of intermittent hemodialysis was observed in 52, 63 % of cases. The average number of hemodialysis sessions was 3. The use of exchanges plasmatic was noted in 26, 31% of cases. The evolution is marked by improvement of renal function in 26.31% of cases, and 31.57% of patients progressed to ESRD while 47.4% remained a chronic kidney disease with a mean clearance to 30,14ml/min (15-46 ml /min). Maternal mortality was noted in 5.26% related to pulmonary embolism. Perinatal fetal mortality was observed in 57.9%. CONCLUSIONS: In developing countries, pregnancy-related acute renal failure remains a frequent and grave complication. It reflects the absence of prenatal care and early detection of high-risk pregnancies, the delay in transfer of patients and the paucity of relevant human and material resources. It is certainly a treatable and curable complication, but one that imposes a heavy burden of maternal morbidity and mortality if its diagnosis and treatment are delayed. The best treatment remains prevention, a goal very difficult to attain in these developing countries, to target women in labor at high risk, and optimize their management, to reduce the incidence of ARF gestational.