Obstetric Renal Failure: A Prospective study

Balamurugan, B (2008) Obstetric Renal Failure: A Prospective study. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : The unique vulnerability of the kidneys in pregnancy was first noted in 1843 when John Lever recognized that proteinuria occurring in association with maternal convulsions was an entity separate from chronic kidney disease. Lever’s observation came 16 years after Richard Bright’s recognition of proteinuria as a marker for kidney disease. The distinction between primary kidney disease and preeclampsia remains one of the most common issues addressed by nephrologists seeing pregnant women. Pregnancy in a woman with kidney disease or the development of primary kidney disease in a pregnant woman has long been recognized as dangerous. In 1936, Dieckman recommended termination of pregnancy if nephrosis occurred before 30 weeks gestation. At that time, not only was there no effective treatment for kidney failure, but antibiotics, steroids, and effective antihypertensive treatment were not available. Women with known kidney disease were discouraged from becoming pregnant, and most of our knowledge about pregnancy in kidney disease has been acquired only because women wanted children ignored the advice of their physicians. In 1970 Lindheimer and Katz observed that successful pregnancy was the rule in women with kidney disease whose kidney function was well preserved. Some investigators associated poor outcomes with specific glomerular lesions, and only later did it become clear that preconception serum creatinine was more important than the specific kidney disease (except in case of lupus nephritis). Until the 1980, most series of pregnancy in women with kidney disease included only a few women with serum creatinine greater than 1.4 mg/dl. Over the following 10 years, more than 7 reports were published detailing 226 pregnancies in 196 women with moderate to severe preexisting kidney disease. Collective experience indicated that these women risked more rapid progression to kidney failure if they became pregnant. At the same time, advances in the care of premature newborns resulted in the survival of more than 90% of infants from pregnancies in this group of women. MATERIALS AND METHODS : All patients who were referred to Department of Nephrology with renal failure complicating pregnancy between Jan 2006 and Jan 2008 were included in this study. Total patients were 52 in number. All of these patients were referred from different parts of Tamilnadu. Most of these patients were referred from Department of Obstetrics attached to our college and from various District headquarters hospital. Their age ranged between 20 and 35 years, the mean being 25.5 years. CONCLUSION : Pregnancy-related ARF has virtually disappeared from the economically advanced countries. This progress is chiefly attributed to legalized abortion, consequently, to a decline in septic abortion, and improvement in antenatal care. The incidence of severe ARF in pregnancy is high in the Indian and septic abortion remains the major cause of ARF. Despite legalization of abortion, good number pregnant women seek abortion from untrained and unlicensed abortionist under unhygienic conditions, probably due to social stigma attached to abortion. In contrast to the low rates of cortical necrosis (1.5%). In early pregnancy in western countries its incidence remains high (25%) in India. The frequency distribution of ARF in pregnancy is still bimodal in Indian subcontinent, where as early peak of ARF in pregnancy has disappeared in the developed countries. Thus, ARF in pregnancy is larger in largely preventable because it is usually the result of obstetric complication and not intrinsic renal disease. With this in mind, pregnancy related acute renal failure could be viewed as a public health problem rather than a nephrological problem.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Obstetric Renal Failure ; Prospective study.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 03:52
Last Modified: 09 Dec 2018 04:27
URI: http://repository-tnmgrmu.ac.in/id/eprint/1365

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