Alexopoulos E, Tambakoudis P, Bili H, Sakellariou G, Mantalenakis S, Papadimitriou M
Department of Nephrology, Aristotelian University of Thessaloniki, Hippokration General Hospital, Greece.
Ren Fail. 1993;15(5):609-13. doi: 10.3109/08860229309069411.
Between 1982 and 1992, 18 cases of pregnancy-related acute renal failure (PR-ARF) were observed (9% of the total number of ARF). Mean age of the women was 32 years (22-40 years). Uterine hemorrhage and preeclampsia/eclampsia were the major causes of ARF, accounting for 61% of the cases. Patchy renal cortical necrosis was suspected in 2 cases whereas signs of disseminated intravascular coagulation (DIC) or microangiopathic hemolytic anemia were present in 6 (33%) and 9 (50%) cases, respectively. Ten women required hemodialysis; and 6 of them, additional plasma exchange sessions. Five patients (28%) died during the acute phase of the illness, mainly due to brain damage, hepatic failure, and sepsis. Among the survivors, a complete (61.5%) or partial recovery (23.1%) was usually seen, but irreversible renal failure was recorded in 2 cases with postpartum hemolytic uremic syndrome (HUS). Short-lasting oligoanuria (< 3 days) represents a good prognostic index. However, the presence of vascular injury (cortical necrosis, HUS) seems to carry a poor prognosis. In conclusion, PR-ARF is still a critical occurrence, associated with serious prognosis for both women and kidneys. So far, the most effective measures remain the careful prevention and the aggressive management of the obstetric complications.
1982年至1992年间，观察到18例妊娠相关急性肾衰竭（PR - ARF）（占急性肾衰竭总数的9%）。这些女性的平均年龄为32岁（22 - 40岁）。子宫出血和先兆子痫/子痫是急性肾衰竭的主要原因，占病例数的61%。2例疑似存在散在性肾皮质坏死，而分别有6例（33%）和9例（50%）出现弥散性血管内凝血（DIC）或微血管病性溶血性贫血的迹象。10名女性需要进行血液透析；其中6名还需要进行血浆置换。5例患者（28%）在疾病急性期死亡，主要原因是脑损伤、肝衰竭和败血症。在幸存者中，通常可见完全恢复（61.5%）或部分恢复（23.1%），但2例产后溶血性尿毒症综合征（HUS）患者出现了不可逆的肾衰竭。短暂少尿（< 3天）是一个良好的预后指标。然而，存在血管损伤（皮质坏死、HUS）似乎预后较差。总之，PR - ARF仍然是一种严重情况，对女性和肾脏的预后都很严重。迄今为止，最有效的措施仍然是仔细预防和积极处理产科并发症。
