an active drug abuse history, as well as absent or poor antenatal care and essentially were ... Excess mortality in Harlem. N. EnglJMed. 1990;322:173-177. 12.
ACUTE RENAL FAILURE IN PREGNANCY: A REVIEW OF CLINICAL OUTCOMES AT AN INNER-CITY HOSPITAL FROM 1986-1996 C. Magnus Nzerue, MD, Karlene Hewan-Lowe, MBBS, and Chudi Nwawka, MD Atlanta, Georgia
Acute renal failure is a serious complication of pregnancy. Over the past few decades, the overall incidence of acute renal failure in pregnancy has decreased in Western societies. In less developed countries, the incidence of acute renal failure in pregnancy has remained high. This retrospective study examined the incidence, morbidity, fetomaternal mortality, and renal prognosis among pregnant inner-city patients. Serum creatinine levels of all pregnant patients seen at an inner-city hospital from January 1986 to December 1996 were reviewed. Twenty-one consecutive cases of acute renal failure were identified for an incidence of 2 in 10,000 pregnancies. Maternal mortality was high (15.7%) as was morbidity, with a tendency toward a high rate of intrauterine fetal growth retardation. These results suggest that the outlook for acute renal failure in innercity patients is dismal in sharp contrast to the prognosis for other patient groups with acute renal failure in pregnancy in Western societies. Preventive strategies should be aimed at this subpopulation with a view to improving early prenatal care as well as enhancing overall access to the health-care system. (J Nati Med Assoc. 1998;90:486-490.)
Key words: renal failure * pregnancy * inner city
Disorders causing acute renal failure in pregnancy fall into three groups. The first group includes disorders in which acute renal failure is coincidental with pregnancy and could well have occurred in absence of pregnancy. The second group consists of those cases in which acute renal failure results from derangements in normal physiologic changes in pregnancy (eg, severe emesis gravidarum), while the third group encompasses diseases that cause acute renal failure and are unique to pregnancy. Advances in modem obstetric care have reduced From the Departments of Medicine and Obstetrics, Morehouse School of Medicine, and the Department of Pathology, Emory University School of Medicine, Atlanta, Georgia. Requests for reprints should be addressed to Dr C. Magnus Nzerue, Dept of Medicine, Morehouse School of Medicine, 720 Westview Dr, SW, Atlanta, GA 30310. 486
acute renal failure to an infrequent event, occurring in about 1 in 10,000 birth in Western societies.1-3 This is a significant change from the 1950s and 1960s, when approximately 22% of all cases of acute renal failure were of obstetric origin.4 Clinical studies in the 1970s and 1980s confirmed this decreasing incidence, but also highlighted the improved survival in patients who develop acute renal failure during pregnancy. This improved survival and decreased incidence was attributed to improved access to abortions (with decreased incidence of septic abortions), and early and more successful intervention in "high-risk"
pregnancies.5'6 This study assessed the epidemiology and clinical outcomes of acute renal failure in pregnant patients at an inner-city hospital.
MATERIALS AND METHODS Between January 1986 and December 1996, the records of patients with acute renal failure in pregJOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 90, NO. 8
ACUTE RENAL FAIWRE IN PREGNANCY
Table 1. Demographic and Clinical Characteristics of Patients With Acute Renal Failure in Pregnancy* Creatinine Level Patient No./ Age (years)/ Race
1/33/AA 2/37/AA* 3/26/AA 4/22/AA 5/19/AA 6/33/AA 7/25/AA 8/26/AA 9/26/AA
10/16/AA 11/25/VA 12/24/AA 13/20/AA 14/26/AA 15/18/AA 16/15/AA 17/17/AA 18/25/AAt 19/27/A 20/46/AA 21/20/AA
Gestation
(Weeks) 28 24 32 16 31 28 33 32 30 38 25 32 30 18 39 31 19 30 30 8 30
Urine Output 3180 3720 1170 720
