Acute renal failure in pregnancy.

From 1976 to 1994, 57 women were referred to the Centro de Nefrología, Montevideo, with obstetric acute renal failure (ARF). The main causes were hypertensive disorders such as preeclampsia (PE) in 27, acute pyelonephritis of pregnancy (APN) in 26, and idiopathic postpartum renal failure in 3. Severe preeclampsia superimposed on chronic hypertension and acute pyelonephritis of pregnancy complicated by sepsis accounted for more than 50% of the cases of ARF. Chronic renal failure developed in 6 patients: 2 had bilateral renal cortical necrosis, 1 had malignant nephrosclerosis, and 3 had idiopathic postpartum renal failure. Maternal mortality related to ARF was low in this group of patients (less than 2%). In contrast, perinatal mortality was strikingly high (40%).