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Am J Kidney Dis. 2016 Jul;68(1):50-7. doi: 10.1053/j.ajkd.2015.11.022. Epub 2016 Jan 16.

Renal Cortical Necrosis in Postpartum Hemorrhage: A Case Series.

Author information

1
Service de Néphrologie, Hôpital Claude Huriez, CHU Lille, Université de Lille, Lille, France. Electronic address: marie.frimat@chru-lille.fr.
2
Service de Néphrologie, Hôpital Victor Provo, Roubaix, France.
3
Service de Néphrologie, CH Valenciennes, Valenciennes, France.
4
Service d'Anatomie Pathologique, APHP, Hôpital Tenon, Paris, France.
5
Service de Radiologie, Hôpital Claude Huriez, CHU Lille, Université de Lille, Lille, France.
6
Centre de Biologie et Pathologie, CHU Lille, Université de Lille, Lille, France.
7
Service de Néphrologie, CHU Tours, Tours, France.
8
Service de Néphrologie, Hôpital Claude Huriez, CHU Lille, Université de Lille, Lille, France.
9
Pôle Femme Mère Nouveau-Né, Hôpital Jeanne de Flandre, EA 2694, PRES Université Lille Nord de France, Lille, France.
10
Pôle de Réanimation, CHU Lille, Université de Lille, Lille, France.
11
Anesthésie-Réanimation, APHP, Hôpital Trousseau, Paris, France.
12
APHP, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France.

Abstract

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.

KEYWORDS:

France; Renal cortical necrosis; TXA dosage; acute kidney injury (AKI); antifibrinolytic; end-stage renal disease (ESRD); obstetric complication; postpartum hemorrhage; pregnancy; tranexamic acid (TXA)

PMID:
26786299
DOI:
10.1053/j.ajkd.2015.11.022
[Indexed for MEDLINE]

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