Outcomes of pregnancy related acute renal failure

To study the outcome of pregnancy related acute renal failure. This observational interventional study was conducted in Nephrology unit, DHQ Hospital, Gomal Medical College, Dera Ismail Khan from April, 2004 to April, 2007. It included 88 pregnant women with established renal failure. Mean age of the patients was 28.5 years. Sixty-five [73.86%] patients had developed renal failure in late and 23[26.14%] in early pregnancy. Sixty-eight [77.28%] were multiparous and 20 [22.72%] were primigravida. Seventy-one [80.68%] women did not receive any form of antenatal care at any stage of pregnancy. A total of 73 [82.96%] patients were oligoanuric and 15 [17.04%] were non-oliguric but all had well established acute tubular necrosis [ATN] secondary to hypotension due to loss of blood, volume depletion or sepsis. Complete renal recovery was observed in 77 [87.5%] patients, out of whom 13 [14.72%] recovered without dialysis support. Eleven patients [12.5%] developed irreversible renal dysfunction. Mean hospital stay was 27.6 days. Mortality was 12.5%, mostly due to sepsis, DIC and multiorgan failure. Those who survived were reevaluated after one year and 87.5% were alive. Pregnancy related acute renal failure is a critical condition, associated with serious prognosis for both women and kidneys. So far, the most effective measures still remain the careful prevention and the aggressive management of the obstetric complications. Ideal care for women with acute renal failure in pregnancy or postpartum requires a multidisciplinary approach that may include maternal-fetal medicine, critical care medicine, nephrology, and neonatology specialities

Outcome of haemodialysis in acute renal failure due to malaria: a single centre study

This study was conducted to find out the outcome of haemodialysis in patients with acute renal failure secondary to malarla. This study was conducted at District Teaching Hospital, Dera Ismail Khan, from January 2004 to December 2004. Patients with acute renal failure secondary to malaria, not responding to fluid challenge and frusemide for twenty-four hours and requiring haemodialysis were finally selected for the study. All these patients were haemodialysed after the requisite workup. Standard antimalarial therapy was continued during haemodialysis. Out of twenty patients [11 females, 9 males], 16 patients [80%] were positive for Plasmodium Falciparum and 4 [20%] were positive for Vivax malaria. The mean blood urea was 110mg/dl and mean serum creatinine was 6.5mg/dl. The other complications of malaria were hypotension [60%], cerebral malaria [20%], intravascular haemolysis and disseminated intravascular coagulation [10% each]. The overall mortality was 20% [n=4/20]. The patients who survived differed only in timing of referral from the initial diagnosis [mean 2 days for patients who survived and mean 4 days for patients who died] and evidence of intravascular haemolysis [mean bilirubin of 4.50 mg/dl for those who survived versus 8.50 mg/dl of those who died]. Two patients, who had developed disseminated intravascular coagulation, could not survive. In acute renal failure complicating malaria, early referral and early haemodialysis has good results in reducing mortality. Haemodialysis along with active treatment with antimalarial has an excellent response in these patients if administered timely