Changes in frequency and etiology of acute renal failure in pregnancy (1980-1997)

In recent years, the incidence of acute renal failure (ARF) in pregnancy has decreased in developed countries. This cause of this decline has been reported to be liberalized abortion laws and improved prenatal care. The aim of this study was to determine if the incidence and etiology of ARE in pregnancy in our population had undergone similar changes. Between January 1, 1980 and January 1 1997 the number of the patients with ARF was 487. In 74 (15%) of these patients, the etiology of ARF was associated with pregnancy. The frequency of ARF in pregnancy was 17.4% between January 1980 and August 1985, 15.4% between September 1985 and November 1989, 13.5% between December 1989 and January 1997 The differences between the frequencies were not statistically significant (p > 0.5). In the present series, the various disorders leading to ARF in pregnancy were abortion (30%), HELP syndrome and pre-eclampsia (14%), preeclampsia or eclampsia (12%), postpartum hemorrhage (15%), fetal death (12%), abruptio placentae (6%) and placentae previa (1%). In 74 patients with ARF in pregnancy, the abortion ratio was 78% in the period 1980-1985 and declined to 19% between 1989 and 1997 (p < 0.001). The frequency of septic abortion also declined from 33.3% to 6.3% during the same periods (p = 0.004). These causes of ARF are similar to those of the industrialized countries because abortion was liberalized by law up to 10-week-gestation in our country in 1983. In the present series, the mean pregnancy number was 5. The mean pregnancy number (7) and the ARF ratio (54%) were highest in the group between 30 and 40 years of age. Is is possible that the high frequency of ARF in pregnancy may depend upon a high pregnancy ratio. Other explanations for the different frequencies of ARF in pregnancy among many countries may be the increase rates of population, fecundity ratios and ratios of delivery supervised by an educated health staff. Consequently, in the present series, the frequencies of abortion and septic abortion decreased due to legalization of abortion in the period 10 week-gestation in our country, but the frequency of ARF in pregnancy is still higher than those of industrialized countries due to high pregnancy ratio.