Bhaduaria Dharmendra, Kaul Anupma, Lal Hiral, Mishra Prabhakar, Jain Manoj, Prasad Narayan, Pradhan Mandakini, Patel Manas Ranjan, Gupta Amit, Sharma Raj Kumar
Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Radio Diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Saudi J Kidney Dis Transpl. 2019 Mar-Apr;30(2):325-333. doi: 10.4103/1319-2442.256839.
Renal cortical necrosis (RCN) is a serious complication of acute kidney injury (AKI) and pregnancy is a clinical state closely associated with it with poor renal outcomes. The incidence is much higher in obstetrical AKI compared to other causes of RCN. Despite better medical care facilities available, this continues to be an important cause of morbidity and mortality in developing countries. This is a retrospective analysis among all pregnant females presenting with AKI from January 1999 to December 2014 at a tertiary care center in the northern part of India. We looked for the incidence of obstetrical-related RCN in our renal biopsies performed in the last 15 years and to evaluate precipitating factors responsible for RCN. RCN constituted 8.3% of pregnancy-related AKI cases in our institution. The overall incidence has been declining which was 9.09% from 1999 to 2008 to 7.8% from 2009 to 2014. The patient's median age was 29.3 ± 5.2 years. The average time to presentation from the day of delivery was 8.7 ±2.1 days. The mortality was observed in 11.7% of them with sepsis and multiorgan dysfunction present in all of them. The most common etiology for RCN was found to be septic abortion and puerperal sepsis accounting for - 15.3% each. Postpartum hemorrhage was a cause in 9.09% of patients. The most important cause of RCN was postpartum thrombotic microangiopathy which was observed in 48.7% of patients. Kidney biopsy was helpful in diagnosis in 31 patients while computed tomography scan abdomen alone helped in diagnosis in five patients. Patchy cortical necrosis in histology was seen in 35.4% of patients and morbidity in terms of prolonged hospitalization was seen in 22.7% while dialysis dependency in 61.5% of the study population. In conclusion, strategies need to be implemented in reducing the preventable causes for RCN which is not only catastrophic in terms of renal outcomes but also for social and psychological perspectives as well.
肾皮质坏死（RCN）是急性肾损伤（AKI）的一种严重并发症，而妊娠是与之密切相关的一种临床状态，肾脏预后较差。与其他导致RCN的原因相比，产科AKI中的发病率要高得多。尽管有更好的医疗设施，但在发展中国家，这仍然是发病和死亡的一个重要原因。这是一项对1999年1月至2014年12月期间在印度北部一家三级护理中心出现AKI的所有孕妇进行的回顾性分析。我们在过去15年进行的肾活检中寻找产科相关RCN的发病率，并评估导致RCN的诱发因素。在我们机构中，RCN占妊娠相关AKI病例的8.3%。总体发病率一直在下降，从1999年至2008年的9.09%降至2009年至2014年的7.8%。患者的中位年龄为29.3±5.2岁。从分娩之日起至就诊的平均时间为8.7±2.1天。其中11.7%的患者死亡，所有死亡患者均出现败血症和多器官功能障碍。发现RCN最常见的病因是感染性流产和产褥期败血症，各占15.3%。9.09%的患者病因是产后出血。RCN最重要的病因是产后血栓性微血管病，48.7%的患者观察到该病因。肾活检对31例患者的诊断有帮助，而仅腹部计算机断层扫描对5例患者的诊断有帮助。35.4%的患者组织学检查可见片状皮质坏死，22.7%的患者出现住院时间延长的情况，而61.5%的研究人群出现透析依赖。总之，需要实施策略来减少RCN的可预防病因，这不仅在肾脏预后方面是灾难性的，而且在社会和心理层面也是如此。
