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Renal Cortical Necrosis in Postpartum Hemorrhage: A Case Series.

Frimat, Marie; Decambron, Melanie; Lebas, Celine; Moktefi, Anissa; Lemaitre, Laurent; Gnemmi, Viviane; Sautenet, Benedicte; Glowacki, François; Subtil, Damien; Jourdain, Mercedes; Rigouzzo, Agnes; Brocheriou, Isabelle; Halimi, Jean-Michel; Rondeau, Eric; Noel, Christian; Provôt, François; Hertig, Alexandre.
Am J Kidney Dis; 68(1): 50-7, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26786299

BACKGROUND:

Pregnancy-related renal cortical necrosis may lead to end-stage renal disease. Although this obstetric complication had virtually disappeared in high-income countries, we have noted new cases in France over the past few years, all following postpartum hemorrhage.

STUDY DESIGN:

Case series. SETTING & PARTICIPANTS: We retrospectively identified 18 patients from 5 French nephrology departments who developed renal cortical necrosis following postpartum hemorrhage in 2009 to 2013.

OUTCOMES:

Obstetric and renal features, therapeutic measures, and kidney disease outcome were studied.

RESULTS:

All patients had a severe postpartum hemorrhage (mean blood loss, 2.6±1.1 [SD] L). Hemodynamic instability and disseminated intravascular coagulation were reported in 5 and 11 patients, respectively. All developed rapid onset of acute kidney injury and required hemodialysis. Diagnosis of renal cortical necrosis was performed 4 to 33 days following delivery. At 6 months postpartum, 8 patients remained dialysis dependent and none recovered normal kidney function. The length of exposure to tranexamic acid treatment was significantly more prolonged in women whose estimated glomerular filtration rate remained <15mL/min/1.73m(2) (7.1±4.8 vs 2.9±2.4 hours; P=0.03).

LIMITATIONS:

Retrospective study; small sample size.

CONCLUSIONS:

In the setting of gravid endothelium, the conjunction of disseminated intravascular coagulation with the life-saving use of procoagulant and antifibrinolytic agents (recently implemented in France in a postpartum hemorrhage treatment algorithm) may give rise to a risk for uncontrolled clotting in the renal cortex and hence irreversible partial or diffuse cortical necrosis.
Selo DaSilva