Renal lesions and acute renal failure in pregnancy

Bilateral renal corticol necrosis associated with calcification: report of a case and a review of aetiology

Clinico-pathological details are given of a patient who survived bilateral renal cortical necrosis for 44 days as a result of treatment by haemodialysis. Cortical calcification was demonstrable radiologically in life and at necropsy. The literature pertaining to renal ischaemic damage and calcification is reviewed. Conclusions are drawn as to the mechanism that produces renal cortical calcification in the light of previous experimental work and the study of the present case. It is suggested that the widespread use of haemodialysis in treatment is likely to result in the detection of an increasing number of such cases.

Acute renal failure in pregnancy

Acute renal failure (ARF) has become a very rare complication of pregnancy. This results from the virtual disappearance of septic abortion ARF and from the improvement of prenatal care, including the prevention of volume contraction which is mainly due to uterine haemorrhage, early diagnosis, and treatment of other classic maternal complications such as pre-eclampsia and acute pyelonephritis. The incidence of bilateral renal cortical necrosis has also been declining during the last decade. Acute fatty liver, a potentially fatal disease, is often complicated by ARF. Early recognition of this disorder, with prompt termination of pregnancy and intensive supportive therapy, can reduce fetal and maternal mortality rate. The syndrome of idiopathic postpartum renal failure is also associated with a high morbidity and mortality. Beyond supportive treatment, including haemodialysis or peritoneal dialysis and the use of potent antihypertensive drugs to control blood pressure and blood transfusion if necessary, specific therapy as plasma infusion, plasma exchange and antiplatelet drugs may be of value. Both peritoneal dialysis and haemodialysis may be used in gravidas with ARF. Early 'prophylactic' dialysis should be applied to pregnant women. Careful monitoring of fluid balance and anticoagulation is necessary during dialysis.

Obstetric acute renal failure 1956-1987

A total of 142 women with severe acute renal failure (ARF) resulting from obstetric causes was treated by dialysis at a single centre from 1956 to 1987. One-year survival was 78.6%, which compares favourably with other causes of ARF. Abortion, haemorrhage and preclampsia comprised 95% of cases, with survival being best (82.9%) with abortion. Survival was adversely affected by increasing age. Acute cortical necrosis (12.7% of patients) carried 100% mortality after 6 years. Follow-up of survivors showed normal renal function up to 31 years following ARF; 25-year patient survival was 71.6%. Improvements in obstetric care and the disappearance of illegal abortions have resulted in a dramatic decline in the incidence of obstetric ARF.

Acute renal failure in pregnancy

Acute renal failure has become a very rare complication of pregnancy. This results from the virtual disappearance of septic abortion ARF and from the improvement of prenatal care, including the prevention of volume contraction which is mainly due to uterine haemorrhage, early diagnosis, and treatment of other classic maternal complications such as pre-eclampsia and acute pyelonephritis. The incidence of BRCN has also been declining during the last decade. Acute fatty liver, a potentially fatal disease, is often complicated by ARF. Early recognition of this disorder with prompt termination of pregnancy and intensive supportive therapy can reduce fetal and maternal mortality rate. The syndrome of idiopathic postpartum renal failure is also associated with a high morbidity and mortality. Beyond supportive treatment including haemo- or peritoneal dialysis, the use of potent antihypertensive drugs to control blood pressure and blood transfusion if necessary, specific therapy as plasma infusion, plasma exchange and antiplatelet drugs may be of value. Both peritoneal dialysis and haemodialysis may be used in gravidas with ARF. Early 'prophylactic' dialysis should be applied to pregnant women. Careful monitoring of fluid balance and anticoagulation is necessary during dialysis.

Recovery from acute renal failure due to "irreversible" glomerular disease

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The use of haemodialysis in acute renal failure and overhydration in children

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