ObstetricsAcute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit☆
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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Cited by (117)
HELLP syndrome at <23 weeks’ gestation: a systematic literature review
2023, American Journal of Obstetrics and GynecologyPreeclampsia and eclampsia: the conceptual evolution of a syndrome
2022, American Journal of Obstetrics and GynecologyCitation Excerpt :Thrombocytopenia and an elevated SGOT (serum glutamic-oxaloacetic transaminase) level are independent risk factors for adverse pregnancy outcomes after adjusting for hypertension and proteinuria. Patients may present with unusual clinical manifestations, such as visual disturbances,85–87 renal failure,88,89 congestive heart failure,63 abdominal pain,90,91 and headaches.92,93. Proteinuria has been a requirement for the diagnosis of preeclampsia for decades, as it reflects renal involvement; however, in the 1990s, several groups of investigators began to question whether proteinuria should be a necessary criterion.94–97
Acute kidney injury in pregnant patients under 20 years of age with severe pre-eclampsia. Experience in a high specialty hospital in Mexico City in 2018-2019
2021, Clinica e Investigacion en Ginecologia y ObstetriciaFactors associated with acute kidney injury during delivery or the postpartum period: A case control study
2021, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Data from a recent South African Cohort study showed that women with pre-eclampsia and AKI had a greater proportion of women who were Stage 3 [9]. Our cohort study demonstrated that the majority of women who suffered pr-AKI recovered renal function after pregnancy, as has been shown in other studies [29]. A small number of women (6/71) failed to attend follow up so their renal status remains unknown.
α-Klotho gene and protein measurements in humans and their role as a clinical biomarker of disease
2021, Fibroblast Growth Factor 23Acute kidney injury in pregnancy including renal disease diagnosed in pregnancy
2019, Best Practice and Research: Clinical Obstetrics and Gynaecology
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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].