Early versus late institution of plasma exchange therapy in pregnancy induced thrombotic microangiopathy and its effects on clinical outcomes

<p>Anupma Kaul</p>

Early versus late institution of plasma exchange therapy in pregnancy induced thrombotic microangiopathy and its effects on clinical outcomes

Anupma Kaul

Sanjay Gandhi Institute of Medical Sciences, India

: Androl Gynecol: Curr Res

Abstract

Background: Renal cortical necrosis is a serious complication of acute kidney injury and pregnancy is a clinical state closely associated with it with poor renal outcomes. The incidence is much higher due to obstetrical AKI compared to other causes of RCN. Despite better medical care facilities available yet this continues to be an important cause of morbidity and mortality in developing countries.

Method: This is a retrospective analysis among all pregnant females presenting with AKI from 1999-2014 at a tertiary care center in northern part of Indi and looked for incidence of obstetrical related renal cortical necrosis in our renal biopsies performed in last one decade and to evaluate precipitating factors responsible for renal cortical necrosis.

Result: RCN constituted 8.3% of PRAKI cases and 52% of all AKI cases in our institution. The overall incidence has been declining which was 9.09% from 2001-2009 to 7.8% from 2009-2015. The median patient age was 29.3±5.2 years. The average time for presentation from the day of delivery was 8.7±2.1 days. The mortality was observed in 11.7% of them with sepsis with multi organ dysfunction contributing to all of them. The etiology of RCN was found to be multifactorial with septic abortion and puerperal sepsis accounting for 15.9% each. Postpartum hemorrhage was a cause in 9.09% patients. The most important cause of RCN was postpartum TMA which was observed in 50% of patients. Kidney biopsy was helpful in diagnosis in 33 patients while CT scan abdomen helped in diagnosis in 11 patients. Patchy cortical necrosis in histology was seen in 34.1% patients and morbidity in terms of prolonged hospitalization was seen in 22.7% while dialysis dependency in 54.5% of the study population.

Conclusion: Strategies need to be implemented in reducing the preventable causes for RCN which is not only catastrophic in terms of renal outcomes but also for social and psychological perspectives as well.