Renal cortical necrosis is a disappearing entity in obstetric acute kidney injury in developing countries: our three decade of experience from India

Figures & data

Figure 1. Distribution of renal lesions (ATN vs RCN) in obstetric AKI in the three study periods.

Figure 2. Occurrence of RCN according to the timing of pregnancy in the three study periods.

Table 1. Number of cases of RCN and obstetric AKI in early and late pregnancy in the three study periods.

		1982–1991			1992–2002			2003–2014
Phase of pregnancy	Total cases of obstetric AKI (n = 65)	ATN	RCN	Total cases of obstetric AKI (n = 125)	ATN	RCN	Total cases of obstetric AKI (n = 69)	ATN	RCN
Early Pregnancy AKI	40	33 (82.5)	7 (17.5)	90	88 (97.8)	2* (2.2)	22	22 (100)	0
Late Pregnancy AKI	25	21 (84)	4 (16)	35	34 (97.2)	1** (2.8)	47	46 (97.8)	1** (2.2)

Notes: Figures in parenthesis represent percentages. AKI = Acute kidney injury, ATN = acute tubular necrosis, RCN = Renal cortical necrosis.

*Diffuse and patchy cortical necrosis one each.

**Only patchy cortical necrosis.

Table 2. Outcome of patients with Renal Cortical Necrosis of all cases of obstetric AKI in the three study periods.

	Study periods			p-Value	p-Value	p-Value
Parameter	1982–1991(A) (n = 65)	1992–2002(B) (n = 125)	2003–2014(C) (n = 69)	A versus B	B versus C	A versus C
Obstetric RCN	11	3	1	<0.05*	0.6	<0.05*
Mortality	8	1	0	0.20	0.50	0.13
Partial recovery of renal function	1	0	1	0.58	<0.05*	<0.05*
Progression to ESRD	2	2	0	0.09	0.24	0.6

Notes: AKI = Acute kidney injury, ATN = Acute tubular necrosis, RCN = Renal cortical necrosis.

*Indicates p-value < 0.05 (statistically significant).

Table 3. RCN in obstetric AKI from developing countries: comparative study.

Authors/year	Study period	Total P-AKI	% of RCN
Chugh KS et al./19766	1965–1975	72	19/72 (26.3%)
Singhal et al./198211	1971–1979	21	9/21 (42.8%)
Prakash J et al./19958	1985–1992	63	15/63 (23.8%)
Naqvi et al./199620	1994	43	9/43 (18%)
Prakash J et al./200621	1982–1991	65	11/65 (17%)
	1992–2002	125	3/125 (2.4%)
Ansari M et al./20082 4	2004–2005	42	9/42 (21%)
Hassan et al./20092 3	2007–2008	43	10/43 (23.25%)
Prakash J et al./201022	2006–2008	85	2/85 (2.3%)
Ali et al./20112 5	2007–2009	100	30%
Prakash J et al./2014 (present study)	2003–2014	69	1/69 (1.44%)

Notes: P-AKI = pregnancy related acute kidney injury; RCN = renal cortical necrosis.

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