**1.8 Recommendations**

80 Novel Insights on Chronic Kidney Disease, Acute Kidney Injury and Polycystic Kidney Disease

failure in hypertensive pregnant women which was conducted over 12 years included 9600 women with hypertension. 31 of these women developed AKI, all were in the postpartum period. Of these there were 2 maternal deaths and 50% of the patients from the preeclamptic group required dialysis. All patients had acute tubular necrosis (ATN). In the chronic hypertensive group with super imposed pre-eclampsia, 42% required dialysis and 3

> Mortality (%)

Smith 1965 70 32 - - - Chugh 1976 72 55.6 - - - Prakash 1995 59 27 - - - Stratta 1996 84 31 7 - - Kilari 2006 41 24.39 - 4 21 Hassan 2009 43 16.2 6 12 18 Khalil 2009 60 15 5 6 28 Khanal 2010 50 8 25 11 14 Prakash 2010 85 20 1 5 59 Arora 2010 57 28.1 3 5 24 Erdemoglu 2010 75 10.6 33.3% (required dialysis)

Sivakumar 2011 59 23.72 - 10.16 54.23

Years 1958- 1967 1968- 1977 1978- 1987 1988- 1994

Table 6. Total Number and Main Causes of PR\_ARF (obstetric AKI) Observed in 37 Years at

Both ante partum or post partum haemorrhage can lead to pre renal azotemia. Haemorrhage due to abruptio placentae has been found to be associated with increased risk of irreversibility of renal function in some series due to the development of cortical necrosis (Turney et al, 1989; Sibai et al, 1993). It is unclear why BRCN occurs more frequently during pregnancy, but this complication has been associated with septic abortions, preeclampsia, abruptio placentae, postpartum accidents, and haemorrhage. Bilateral renal cortical necrosis has been frequently mentioned to be associated with irreversibility of the renal function (Turney et al, 1989).

Foetal outcome is also poor. Intra-uterine death and still birth has been reported as high as 30-70% (Ali et al, 2004; Prakash et al, 2007; Khanal et al, 2010). High incidence of foetal loss was associated with increased incidence of dialysis dependency in mothers. This could be owing to the increased severity of illness (Khanal et al, 2010). Perinatal mortality is

ARF (AKI) 60 298 535 562 PR-ARF 26(43%) 40(13.4%) 15(2.8%) 3(0.5%)

Department of Nephrology and Clinical Obstetrics Torino, Italy (P Stratta,1996).

Dialysis dependent

48 - - -

Partial renal recovery Complete renal recovery

had cortical necrosis (Sibai et al, 1990).

Author Year Study Pop

Knapp 1957 23/32000

Table 5. Renal outcome in Obstetric AKI.

with AKI

deliveries

American college of obstetricians and gynaecologist guidelines Society of Obstetric Medicine of Australia and New Zealand guidelines Royal college of obstetricians and gynaecologists guidelines WHO Guidelines on reproductive and sexual health
