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Obstetric Acute Renal Failure on the Rise, but Why? — Physician’s First Watch

Medical News |
July 31, 2014

Obstetric Acute Renal Failure on the Rise, but Why?

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM

Obstetric acute renal failure appears to be on the rise, and while the reasons are largely unknown, peripartum treatment for preeclampsia may play a role, according to a BMJ study.

Examining data on nearly 2.2 million hospital deliveries in Canada from 2003 to 2010, researchers found that the rate of obstetric acute renal failure increased over the study period, from 1.66 to 2.68 cases per 10,000 deliveries. This increase was observed only among women with hypertensive disorders — in particular, those with gestational hypertension and significant proteinuria (i.e., preeclampsia).

The authors say the increase in obstetric acute renal failure might be due to increased nonsteroidal anti-inflammatory drug use, or to recent recommendations to treat preeclampsia with peripartum fluid restriction — which, while effective, can lead to renal failure through hypovolemia and renal hypoperfusion. The authors conclude that "clinicians managing women with preeclampsia should carefully monitor them for signs of impending renal failure and take appropriate steps to mitigate the risk of further kidney injury."

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