Obstetrics
Acute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit

https://doi.org/10.1067/mob.2002.120279Get rights and content

Abstract

Objective: To determine risk factors and outcomes for women with severe preeclampsia and renal failure. Study Design: Retrospective study from 1995 to 1998 of all women with renal failure who were admitted to the obstetric intensive care unit at Groote Schuur Hospital, South Africa. A total of 89 women were identified with severe preeclampsia defined as blood pressure ≥160/110 mm Hg and ≥2+ proteinuria, renal failure defined as a creatinine level of ≥1.13 mg/dL, and oliguria defined as <100 mL urine produced in 4 hours; 72 charts were available for analysis. A comparison was made between the 3 groups, which were defined by the maximum recorded creatinine levels. Results: Of the 72 women, 31 women (43%) were primiparous and 41 (57%) were multiparous. Median gestation at delivery was 32 weeks (range, 21-40 weeks). The median maximum creatinine was 3.85 mg/dL (range, 1.13-12.50 mg/dL). Twelve women (16%) had a history of chronic renal disease or hypertension, and 36 women (50%) had HELLP syndrome and 23 (32%) abruptio placentae. All women with severe renal impairment had either abruptio placentae or hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Perinatal mortality was 38% (27/72). However, in this series only 7 women (10%) required dialysis in the short term and none required long-term dialysis or kidney transplant. There were no maternal deaths. Conclusions: In women with severe preeclampsia and renal failure, major obstetric complications were common and perinatal outcome was poor. However, the need for dialysis was infrequent, with only 10% women requiring transient dialysis, and there were no cases of chronic renal failure that required dialysis or kidney transplant. (Am J Obstet Gynecol 2002;186:253-6.)

Section snippets

Methods

Groote Schuur Hospital is a tertiary referral unit for the entire metropolitan area of the Western Cape Peninsula of South Africa that covers 28,000 deliveries per annum. All medical problems that complicate pregnancy are referred to the obstetric service at Groote Schuur Hospital. The Maternity Centre at the hospital has an obstetrician-led ICU, with facilities for ventilation and invasive monitoring. At the time of this study, the majority of hospital admissions were for complications of

Results

During the 3-year study period, Groote Schuur Hospital provided tertiary care to a maternity population of 94,500 women, of whom 5200 had hypertensive complications of pregnancy. A total of 588 women were admitted to the obstetric ICU. Of these, 89 had a blood pressure reading of ≥160/110 mm Hg, a reading on urine dipstick of ≥2+ proteinuria, and a serum creatinine level of ≥1.13 mg/dL.

Patient records were located for only 72 women; the remaining 17 records could not be found. Of the 72 women

Comment

This current study is unique in several aspects. The relative rarity of acute renal failure nowadays, compared with data from 30 years ago is confirmed (1:1060). This study reflects a higher rate of renal failure than does the Sibai's3, 4 series; however, Sibai restricted his study to women with HELLP syndrome. The difference in the incidence of renal failure may be due to referral pattern, population, or the definition employed. The current study is a true population-based study because we run

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Reprint requests: AJ Drakeley, MRCOG, Department of Obstetrics & Gynaecology, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK. E-mail: [email protected] or [email protected].

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