Ann. Pak. Inst. Med. Sci. 2011; 7(2): 57-61                

Objective: To determine the clinical spectrum of pregnancy related acute renal failure (PR-ARF) and its outcome in terms of maternal and fetal morbidity and mortality.
Study Design: Case series
Place and duration: Department of Nephrology, Pakistan Institute of Medical Sciences, Islamabad from May 2009- April 2010.
Materials and Methods: PR-ARF was diagnosed with sudden onset oligoanuria or serum creatinine elevated to above 1.5 mg% on two consecutive occasions . Patients with underlying CKD were excluded from the study.
Results: 346 patients with acute renal failure were admitted in one year. 51 women fulfilled the criteria of PR-ARF. Frequency of PR-ARF was 51/346(14.7%). The clinical spectrum included 20/51(39.2%) cases of PIH/ PET / eclampsia with or without sepsis/DIC. 7/51(13.7%) had Acute tubular Necrosis (ATN), 10/51 (19.6%) had puerperal sepsis. 12/51(23.5%) had sepsis along with ATN, out of these 3 had septic abortion. RPGN 1/51 (1.9 %) and acute cortical necrosis 1/51 (1.9%) respectively. Pregnancy related ARF was seen mostly in third trimester/post partum in 46/51(90.2 %). It followed vaginal delivery in 32/51 (62.7%) patients and in 15/51 (29.4%) cases after cesarean section, and 3/51 (5.8%) patients after septic abortion with Dai handling. Dai (traditional birth attendant) handling was found in 17/51 (33.3 %).Antenatal care was not available to 39/51(76.4 %). Maternal outcome showed that 17/51 (33.3%) patients died 25/51 (49.0%) showed complete recovery, 2/51 (3.9%) had partial recovery, whereas irreversible renal failure in 4/51 (7.8 %). Outcome was unknown in 3/51(5.8 %).
Conclusion: Most common cause of pregnancy related acute renal failure is PIH associated with other risk factors like abruption, IUD, DIC and RPOC. Sepsis is the main contributory factor in PR-ARF. No antenatal care and Dai handling was seen in most of patients. Pregnancy related acute renal failure has a very high maternal mortality and morbidity.
Key Words: Acute renal failure, Pregnancy related Acute Renal failure, Clinical spectrum.