**3. References**


cortical necrosis (6 weeks). CT scanning demonstrates hypoechoic or hypodense areas in renal cortex or may demonstrate cortical tram track calcification by 3 weeks. Angiogram shows abrupt cut off of vascularity which is called pruning. No specific therapy is effective. Many patients develop chronic kidney disease. In our study from Osmania General Hospital, Hyderabad, India over 7 years there were total of 105 patients with Renal cortical necrosis (RCN). The mean age was 28.125 ± 12.40 years. Forty one cases (39.04%) resulted from obstetric complications. The most common histology type of RCN was patchy cortical necrosis in 65 patients (62%). All patients required dialysis and the mean duration of dialysis was 3 ± 1weeks. Thirty three (31.42%) patients progressed to end stage kidney disease while 3 underwent renal transplantation. 10(9.5%) patients succumbed to the acute

May be seen in HUS with glomerular and arteriolar fibrinoid necrosis and thrombi.

Early dialysis is necessary in pregnant women with renal failure and should be considered when the serum creatinine reaches 3.5 mg/dL or the glomerular filtration rate (GFR) is less than 20 mL/min or blood urea nitrogen is more than 100mg/dl. Longer, more frequent dialysis (20 h/wk) is associated with the best fetal outcome. Hemodialysis may therefore be necessary at least 5 days per week. Careful avoidance of hypotension is important. As pregnancy is a procoagulant state the dose of heparin needs to be increased. Peritoneal dialysis with smaller volumes and frequent exchanges is another option. Peritoneal dialysis may be difficult in the third trimester due to increased uterine size. Premature labor and fetal size that is small for the gestational age are typical in women who deliver on dialysis. Nutritional support that allows weight gains of 0.3 to 0.5 kg/wk should be maintained in the second and third trimesters. Although the spontaneous abortion rate is approximately 50% for pregnant women who require dialysis, the fetal survival rate for pregnancies that

ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia.

American College of Obstetrics and Gynecology (2004)ACOG (American College of

August P, Mueller FB, Sealey JE, Edersheim TG. (1995) Role of rennin angiotensin system in

Ananth Karumanchi S ,Franklin H Epstein (2007)Renal complications in pregnancy In

blood pressure regulation in pregnancy. *Lancet* , 345:896–897.

Number 33, January 2002.ACOG Committee on Practice Bulletins—

Obstetrics and Gynecology) Practice Bulletin: nausea and vomiting of pregnancy.

*Comprehensive Clinical Nephrology: edn 3rd Edited by John Feehally, Jurgen Floege,* 

kidney injury (AKI).(Manisha Sahay)

Glomeruli show mesangiolysis and glomerular simplification.

Obstetrics,Obstet Gynecol. 2002;99(1):159.

*Richard J. Johnson .Mosby Elsevier* .483-504.

Obstet Gynecol. ;103(4):803.

**2.2.5 Vascular changes** 

**2.3 Dialysis in pregnancy** 

continue is as high as 71%.

**3. References** 


**8** 

Itir Yegenaga

*Turkey* 

*Department of Internal Medicine* 

**Evaluation of Acute Kidney** 

**Injury in Intensive Care Unit** 

Acute kidney injury (AKI), impairment of kidney function requires special attention in intensive care unit's (ICU), because if multiorgan failure affect the kidney, it carries a greater risk for worse outcome and furthermore survivors have higher risk then normal population for chronic renal failure. It was reported that they also have higher mortality and morbidity

Acute tubular necrosis (ATN) is the primary causes of AKI in hospital and ICU and sepsis, ischemic or toxic insults were reported as the most common reason for ATN. The rates of AKI have been reported in hospitalized patients to be between 3.2%-20% and in ICUs this rate rises up to 22% and even to 67% depending on the population studied and the definition used (Murugan 2011). Based on the administrative data, the incidence of severe AKI (defined requiring dialysis) from 1988 to2002 has increased from 4 to 27 per 100000 population. But fortunately in hospital mortality, has decreased from 41.3 to28 % (p<0.001) (Waikar, 2008). Likewise a progressive 2.8% annual increase in incidence of AKI and progressive 3.8% annual decrease in AKI associated mortality(95%CI:-4.7 to-2.12:p<0.001) was observed from 1996-2005 in a large database in Australia and New Zealand (Pisoni, 2008&Bagshaw, 2007). Despite the fact that mortality might be decreasing in ICU patients with AKI, it is still high and reported to be up to 43-88%. Mortality rate becomes even higher

Interestingly, it was reported that irreversible AKI requiring chronic dialysis therapy increased from 3.7% in 1984 to 18.2% in 1995 in surviving patients. Even higher number of patients (33-68%) at discharge whose kidney failed to recover and who needed long term dialysis. This changing renal outcome in the survivors of ICU acquired AKI cases might be related to increasing number of older patients, several co morbid conditions, more severe AKI cases than before and in addition, complication of the more aggressive renal

Since AKI in critical ill patients have high mortality rate and even if patients survive, they are at risk for End Stage Renal Disease (ESRD) and higher mortality than the normal population, it is important to recognize the clinical picture of AKI and to institute prevention as early as possible. Thus, physician should be alarmed and be ready for early intervention in this particular group of patients. With the introduction of the RIFLE

rates compared to normal population (Kellum, 2008 & Shiffle, 2006).

when patients require renal replacement therapy (Kellum, 2008).

replacement therapies currently used (Shiffle, 2006).

**1. Introduction** 

*University of Kocaeli Medical School, Kocaeli* 

