Spectrum of Pregnancy Related Renal Cortical Necrosis: A Study From Western India

Abstract

Background: Pregnancy complicated by acute kidney injury is associated with higher morbidity and mortality in developing countries. The occurrence of renal cortical necrosis (RCN) in pregnancy related acute kidney injury may lead to grave renal prognosis. Objectives: This study is to analyse the risk factors that lead to acute cortical necrosis in all cases of pregnancy related acute kidney injury presenting in a tertiary care institute in Western India from January 2021 to July 2021, and assess the renal outcomes. Materials and Methods: Patients with pregnancy related acute kidney injury suspected to have a clinical profile of acute cortical necrosis, were subjected to histopathological and/or radiological examination for confirmed diagnosis. 4 patients were included in this case series. The etiology of the cases leading to cortical necrosis were analysed. Their prognosis was studied in terms of patient and renal outcomes for a period of 3 months postpartum. Results: The patients median age was 31 years. The most common aetiology was postpartum haemorrhage seen in 3 cases. The presence of postpartum thrombotic microangiopathy seen in one case is an important cause of RCN. Three of our four patients (75%) showed diffuse cortical necrosis. All needed renal replacement therapy at presentation. Two patients (50%) showed partial recovery of renal functions and became dialysis independent at 3 months postpartum.Conclusions: This study emphasises the need for early diagnosis and timely institution of appropriate management in cases of obstetric AKI with renal cortical necrosis to curtail the morbidity and mortality in young women.