Book of Medical Disorders in Pregnancy - Tintash

Hyperparathyroidism, an uncommon
cause of renal calculi should be ruled
out.
Acute renal failure:
This is an uncommon but serious complication
of pregnancy. The incidence
has been reported as varying between
one in 1400 and one in 5,000 pregnancies,
prior to the change in abortion laws
in North America, in the era of frequent
septic abortion, many women presented
to this unit in acute renal failure as the
result of sepsis or blood loss initiated by
a criminal abortion. The other common
groups of cases of acute renal failure we
see are in late pregnancy, where the
condition develops as a complication of
abruptio placentae, toxanemia, sepsis,
hemorrhage, amnionitis, or other rare
renal conditions. In our own unit, prior
to the development of adequate renal
dialysis and now renal transplant, the
maternal mortality associated with late
pregnancy acute renal failure was
approximately 25%. These figures have
been reduced in latter years with more
sophisticated modalities of treatment.
The management of patients with acute
renal failure is a complicated, labour,
intensive situation. I will attempt to refer
in generalities to some of the principles
that should be adhered to. In risk
situations i.e., abruptio placentae, severe
toxemia, sepsis, severe hemorrhage and
amnionitis, vigilant observation of the
urinary output is mandatory. It goes
without saying that vigorous treatment
of the underlying cause, particularly
abruptio placentae, must be undertaken.
Regrettably, in the development of acute
renal failure often the physician incharge
has incorrectly assessed the am-
96
ount of blood and fluid lost, proper replacement
of the appropriate agents -
fluid, blood and electrolytes cannot be
over emphasized. If oliguria presents
(i.e., urinary output under 400 cc, in 24hours)
or anuria is present or anticipated,
or an increasing BUN. is noted, the
general principles of management should
include:-
Fig6.8: Shows cut section of kidney.
Fluid restriction to 400 cc. for 24 hours,
plus measured loss; Low protein, highcarbohydrate,
high fat, diet;
The use of ion exchange resins to
protect against hyperkaliemia: Where
sepsis exists, appropriate antibiotic therapy
must be instituted. The nephrotoxicity
of commonly used antibiotic
agents must be considered in dealing