Renal Cortical Necrosis Is the Most Common Histopathological Finding in Obstetric Acute Kidney Injury in a Developing Country
Anila Kurien, N Gopalakrishnan, Arpita Raychowdhury, Georgi Abraham. Madras Medical Mission, Chennai, Tamil Nadu, India; Madras Medical College, Chennai, Tamil Nadu, India; Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
Background: Obstetric acute kidney injury is not uncommon in a developing country and is a significant cause of maternal morbidity and mortality. Poverty, lack of awareness and poor accessibility to obstetric care are the probable reasons. This study was done to analyze the spectrum of histopathological changes seen in pregnant women biopsied for acute kidney injury (AKI).
Design: All native kidney biopsies reported over 18 months (April 2011 to September 2012) in the renal pathology division of a tertiary care referral centre in southern India were analyzed. Biopsies from 85 centers, from rural as well as urban regions across India are processed here. AKI was the indication in 307 biopsies (11.3%) out of 2695 native kidney biopsies during the time period. Obstetric AKI was found in 39 patients (12.7% of all biopsied AKI). Age, clinical presentation and histopathological diagnosis were analyzed in patients biopsied for obstetric AKI.
Results: The age range was 19 to 34 years, with a mean of 24.3 years. Acute renal failure occurred in association with septic abortions or puerperal sepsis in 10 patients (25.6 %), preeclampsia or eclampsia in 10 patients (25.6 %), postpartum hemorrhage in 6 patients (15.4 %), hemolytic uremic syndrome in 4 patients (10.2 %), HELLP syndrome in 3 patients (7.7 %) and 2 patients (5.1 %) each for intrauterine death of fetus, abruptio placentae and retained products of conception. Renal histology showed cortical necrosis (patchy or diffuse) in 20 patients (51.3 %), extensive tubular necrosis in13 patients (33.3 %) and thrombotic microangiopathy in 6 patients (15.4 %). Renal cortical necrosis was reported in 26 out of the 2695 native kidney biopsies (0.96%). Obstetric complication was the most common cause (76.9%) of renal cortical necrosis in our study.
Conclusions: Cortical necrosis which is extremely rare in the western world is a common histopathological finding in patients with obstetric AKI in a developing country.
Category: Kidney (does not include tumors)
Monday, March 4, 2013 1:00 PM
Poster Session II # 248, Monday Afternoon