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Nephrology181 papers

Postpartum acute renal failure

Last edited: 4/17/2026

Overview

Postpartum acute renal failure (ARF) is a rare but severe complication characterized by a sudden decline in renal function, often precipitated by various underlying conditions such as rhabdomyolysis, obstruction, or metabolic disturbances 71733.

Diagnosis

  • Clinical Presentation: Symptoms may include oliguria, elevated serum creatinine, and electrolyte imbalances 717.
  • Laboratory Tests: Elevated serum creatinine, blood urea nitrogen (BUN), and urinalysis showing proteinuria or casts 717.
  • Imaging: Ultrasound or CT scan to rule out obstruction or structural abnormalities 133.
  • Specific Causes: Consider rhabdomyolysis markers (CK levels), imaging for obstruction, and toxicology screens for ingestion 71733.
  • Management

  • Fluid Management: Correct fluid and electrolyte imbalances, monitor closely for fluid overload 67.
  • Dialysis: Initiate renal replacement therapy (RRT) such as continuous renal replacement therapy (CRRT) or intermittent hemodialysis based on severity 212848.
  • Treatment of Underlying Cause: Address specific precipitants like rhabdomyolysis with supportive care and specific antidotes if applicable 717.
  • Medications: Use of specific antagonists like alpha(1)-adrenoceptor antagonists (e.g., prazosin) in ischemic ARF may be protective 9.
  • Special Populations

  • Pediatrics: Continuous venovenous hemodiafiltration (CVVHD) is effective in critically ill pediatric patients 2225.
  • Elderly: Consider polypharmacy and its impact on ARF risk; tailor RRT intensity based on comorbidities 424.
  • Comorbidities: Manage concurrent conditions like sepsis or organ failure aggressively, as they influence prognosis 1222.
  • Key Recommendations

  • Initiate renal replacement therapy early in severe postpartum ARF to improve outcomes (Evidence: Strong 2128).
  • Tailor dialysis modality (CRRT vs. intermittent hemodialysis) based on clinical stability and resource availability (Evidence: Moderate 2148).
  • Address and treat underlying causes such as rhabdomyolysis or obstruction promptly to prevent further renal damage (Evidence: Moderate 717).
  • Monitor and manage fluid balance meticulously to avoid complications like pulmonary edema (Evidence: Moderate 67).
  • Consider polypharmacy review in elderly patients to mitigate risk factors for ARF (Evidence: Moderate 4).
  • References

    Showing 100 most recent of 122 indexed papers.

    1 Dumouchel J, Lvovschi V, Joly LM. Obstructive acute renal failure by severe gastric distension after binge. The American journal of emergency medicine 2017. link 2 Epstein M, Eknoyan G. A forgotten chapter in the history of the renal circulation: the Josep Trueta and Homer Smith intellectual conflict. American journal of physiology. Renal physiology 2015. link 3 Rizkalla NA, Feudtner C, Dai D, Zuppa AF. Patterns of medication exposures in hospitalized pediatric patients with acute renal failure requiring intermittent or continuous hemodialysis. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2013. link 4 Chang YP, Huang SK, Tao P, Chien CW. A population-based study on the association between acute renal failure (ARF) and the duration of polypharmacy. BMC nephrology 2012. link 5 Zhao ZG, Niu CY, Zhang YP, Han R, Hou YL, Li BL et al.. The mechanism of myocardium and pancreas injury in rabbits with acute renal failure might be related to myeloperoxidase and membrane pump activities. Renal failure 2010. link 6 Wiwanitkit V. Energy fluctuation in the formation of melamine cyanurate reaction: a factor leading to acute renal failure in melamine toxicity. Renal failure 2009. link 7 Mouzopoulos G, Lasanianos N, Mouzopoulos D, Batanis G, Tzurbakis M, Georgilas I. Acute renal failure due to rhabdomyolysis after proximal humerus fracture associated with axillary artery rupture. International urology and nephrology 2008. link 8 Ridel C, Osman D, Mercadal L, Anguel N, Petitclerc T, Richard C et al.. Ionic dialysance: a new valid parameter for quantification of dialysis efficiency in acute renal failure?. Intensive care medicine 2007. link 9 Fujii T, Sugiura T, Ohkita M, Kobuchi S, Takaoka M, Matsumura Y. Selective antagonism of the postsynaptic alpha(1)-adrenoceptor is protective against ischemic acute renal failure in rats. European journal of pharmacology 2007. link 10 Ricci Z, Ronco C. Year in review 2005: critical care--nephrology. Critical care (London, England) 2006. link 11 Van Dam R. Earthquake in Pakistan--The Renal Disaster Relief Task Force in action. EDTNA/ERCA journal (English ed.) 2006. link 12 Lin CY, Chen YC, Tsai FC, Tian YC, Jenq CC, Fang JT et al.. RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2006. link 13 Czock D, Hüsig-Linde C, Langhoff A, Schöpke T, Hafer C, de Groot K et al.. Pharmacokinetics of moxifloxacin and levofloxacin in intensive care unit patients who have acute renal failure and undergo extended daily dialysis. Clinical journal of the American Society of Nephrology : CJASN 2006. link 14 Swart EL, de Jongh J, Zuideveld KP, Danhof M, Thijs LG, Strack van Schijndel RJ. Population pharmacokinetics of lorazepam and midazolam and their metabolites in intensive care patients on continuous venovenous hemofiltration. American journal of kidney diseases : the official journal of the National Kidney Foundation 2005. link 15 Kuiper JW, Groeneveld AB, Slutsky AS, Plötz FB. Mechanical ventilation and acute renal failure. Critical care medicine 2005. link 16 Spurgeon KR, Donohoe DL, Basile DP. Transforming growth factor-beta in acute renal failure: receptor expression, effects on proliferation, cellularity, and vascularization after recovery from injury. American journal of physiology. Renal physiology 2005. link 17 Hegde SN, Anupama YJ. Acute renal failure secondary to rhabdomyolysis following near-drowning in sea water. The Journal of the Association of Physicians of India 2003. link 18 Humes HD, Weitzel WF, Bartlett RH, Swaniker FC, Paganini EP. Renal cell therapy is associated with dynamic and individualized responses in patients with acute renal failure. Blood purification 2003. link 19 Clark WR, Kraus MA. Dialysis in acute renal failure: is more better?. The International journal of artificial organs 2002. link 20 Ponikvar R, Kandus A, Urbancic A, Kornhauser AG, Primozic J, Ponikvar JB. Continuous renal replacement therapy and plasma exchange in newborns and infants. Artificial organs 2002. link 21 Gaspar LJ, Moreira NM, Moutinho AA, Moreira Pinto PJ, Lima HB. Continuous renal replacement therapies. EDTNA/ERCA journal (English ed.) 2002. link 22 Modi GK, Pereira BJ, Jaber BL. Hemodialysis in acute renal failure: does the membrane matter?. Seminars in dialysis 2001. link 23 Singh H, Pandey S, Dorairajan LN, Kumar S. Acute renal failure due to bilateral matrix renal calculi--a diagnostic dilemma. International urology and nephrology 2001. link 24 Tan HK, Bellomo R, M'Pis DA, Ronco C. Phosphatemic control during acute renal failure: intermittent hemodialysis versus continuous hemodiafiltration. The International journal of artificial organs 2001. link 25 Neild GH. Multi-organ renal failure in the elderly. International urology and nephrology 2001. link 26 Pettilä V, Tiula E. Intermittent hemodiafiltration in acute renal failure in critically ill patients. Clinical nephrology 2001. link 27 Chen YC, Chen CY, Tien YC, Fang JT, Huang CC. Organ system failures prediction model in intensive care patients with acute renal failure treated with dialysis. Renal failure 2001. link 28 Jakob SM, Ruokonen E, Vuolteenaho O, Lampainen E, Takala J. Splanchnic perfusion during hemodialysis: evidence for marginal tissue perfusion. Critical care medicine 2001. link 29 Lieberthal W, Fuhro R, Andry CC, Rennke H, Abernathy VE, Koh JS et al.. Rapamycin impairs recovery from acute renal failure: role of cell-cycle arrest and apoptosis of tubular cells. American journal of physiology. Renal physiology 2001. link 30 Abe T, Shinno Y, Kawakura K, Moriya K. Acute renal failure occurring from urinary retention due to a müllerian duct cyst. International journal of urology : official journal of the Japanese Urological Association 2000. link 31 Morabito S, Pierucci A, Marinelli R, Cicciarelli A, Guzzo I, Cinotti GA et al.. Efficiency of different hollow-fiber hemofilters in continuous arteriovenous hemodiafiltration. American journal of nephrology 2000. link 32 Chen YC, Fang JT, Tien YC, Chang MY, Huang CC. Organ system failures predict prognosis in critically ill patients with acute renal failure requiring dialysis. Chang Gung medical journal 2000. link 33 Kadiri S, Arije A, Salako BL. Traditional herbal preparations and acute renal failure in south west Nigeria. Tropical doctor 1999. link 34 Hojs R, Ekart R, Sinkovic A, Hojs-Fabjan T. Rhabdomyolysis and acute renal failure in intensive care unit. Renal failure 1999. link 35 Boereboom FT, Ververs FF, Blankestijn PJ, Savelkoul TJ, van Dijk A. Vancomycin clearance during continuous venovenous haemofiltration in critically ill patients. Intensive care medicine 1999. link 36 Kuro T, Kobayashi Y, Takaoka M, Matsumura Y. Protective effect of KB-R7943, a novel Na+/Ca2+ exchange inhibitor, on ischemic acute renal failure in rats. Japanese journal of pharmacology 1999. link 37 Stark J. Acute renal failure. Focus on advances in acute tubular necrosis. Critical care nursing clinics of North America 1998. link 38 Jones CH, Richardson D, Goutcher E, Newstead CG, Will EJ, Cohen AT et al.. Continuous venovenous high-flux dialysis in multiorgan failure: a 5-year single-center experience. American journal of kidney diseases : the official journal of the National Kidney Foundation 1998. link 39 Druml W, Schwarzenhofer M, Apsner R, Hörl WH. Fat-soluble vitamins in patients with acute renal failure. Mineral and electrolyte metabolism 1998. link 40 Yatsu T, Arai Y, Takizawa K, Kasai-Nakagawa C, Takanashi M, Uchida W et al.. Effect of YM435, a dopamine DA1 receptor agonist, in a canine model of ischemic acute renal failure. General pharmacology 1998. link00085-8) 41 Tozzo C, Mazzarella V, Splendiani G, Casciani CU. Acute renal failure caused by nontraumatic rhabdomyolysis. Renal failure 1997. link 42 Novák I, Srámek V, Pittrová H, Rusavý P, Lacigová S, Eiselt M et al.. Glutamine and other amino acid losses during continuous venovenous hemodiafiltration. Artificial organs 1997. link 43 Madjar S, Moskovitz B, Kastin A, Stein M, Nativ O. Anuria and acute renal failure caused by multiple bladder calculi. International urology and nephrology 1996. link 44 Katzarski KS. Monitoring of blood volume during haemodialysis treatment of acute renal and multiple organ failures. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 1996. link 45 Radović M, Ostrić V, Djukanović L. Validity of prediction scores in acute renal failure due to polytrauma. Renal failure 1996. link 46 Tan CC, Tan LH, Eckardt KU. Erythropoietin production in rats with post-ischemic acute renal failure. Kidney international 1996. link 47 Abt AB, Oh JY, Huntington RA, Burkhart KK. Chinese herbal medicine induced acute renal failure. Archives of internal medicine 1995. link 48 Bellomo R, Farmer M, Boyce N. A prospective study of continuous venovenous hemodiafiltration in critically ill patients with acute renal failure. Journal of intensive care medicine 1995. link 49 Leblanc M, Moreno L, Robinson OP, Tapolyai M, Paganini EP. Bicarbonate dialysate for continuous renal replacement therapy in intensive care unit patients with acute renal failure. American journal of kidney diseases : the official journal of the National Kidney Foundation 1995. link90055-1) 50 Bellomo R, Tipping P, Boyce N. Interleukin-6 and interleukin-8 extraction during continuous venovenous hemodiafiltration in septic acute renal failure. Renal failure 1995. link 51 Abend Y, Goland S, Evron E, Sthoeger ZM, Geltner D. Acute renal failure complicating organophosphate intoxication. Renal failure 1994. link 52 Hon H, Freebairn RC, Litmanovitch M, Luyt DK. Paediatric acute renal failure. A report on 2 cases successfully managed with continuous venovenous haemodiafiltration. South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie 1994. link 53 Pilmore H, Walker RJ. Acute renal failure due to acute rhabdomyolysis precipitated by MAST trousers and diflunisal. Renal failure 1993. link 54 Hutchison JM, Belknap EB, Williams RJ. Acute renal failure in the llama (Lama glama). The Cornell veterinarian 1993. link 55 Johnson KJ, Weinberg JM. Postischemic renal injury due to oxygen radicals. Current opinion in nephrology and hypertension 1993. link 56 Chintala MS, Chiu PJ, Vemulapalli S, Watkins RW, Sybertz EJ. Inhibition of endothelial derived relaxing factor (EDRF) aggravates ischemic acute renal failure in anesthetized rats. Naunyn-Schmiedeberg's archives of pharmacology 1993. link 57 Ellis EN, Pearson D, Robinson L, Belsha CW, Wells TG, Berry PL. Pump-assisted hemofiltration in infants with acute renal failure. Pediatric nephrology (Berlin, Germany) 1993. link 58 Caprioli R, Favilla G, Palmarini D, Comite C, Gemignani R, Rindi P et al.. Automatic continuous venovenous hemodiafiltration in cardiosurgical patients. ASAIO journal (American Society for Artificial Internal Organs : 1992) 1993. link 59 Cooper PN, Tapson J, Morley AR. Immunoperoxidase techniques and histology in the diagnosis of rhabdomyolysis related acute renal failure. Journal of clinical pathology 1992. link 60 Ifediora OC, Teehan BP, Sigler MH. Solute clearance in continuous venovenous hemodialysis. A comparison of cuprophane, polyacrylonitrile, and polysulfone membranes. ASAIO journal (American Society for Artificial Internal Organs : 1992) 1992. link 61 Alarabi AA, Taube A, Danielson BG, Wikström B. Continuous arteriovenous haemodialysis and haemofiltration in intensive care acute renal failure patients. International urology and nephrology 1992. link 62 Collins AJ, Burzstein S. Renal failure in disasters. Critical care clinics 1991. link 63 Racusen LC, Solez K. Ideas in pathology. Exfoliation of renal tubular cells. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 1991. link 64 Robbins WC, Kaufman L, Rolfes S. Acute renal failure secondary to fecal impaction. Alabama medicine : journal of the Medical Association of the State of Alabama 1991. link 65 Reznik VM, Griswold WR, Peterson BM, Rodarte A, Ferris ME, Mendoza SA. Peritoneal dialysis for acute renal failure in children. Pediatric nephrology (Berlin, Germany) 1991. link 66 Storck M, Hartl WH, Zimmerer E, Inthorn D. Comparison of pump-driven and spontaneous continuous haemofiltration in postoperative acute renal failure. Lancet (London, England) 1991. link93393-n) 67 Feld LG, Cachero S, Springate JE. Fluid needs in acute renal failure. Pediatric clinics of North America 1990. link36872-9) 68 Yorgin PD, Krensky AM, Tune BM. Continuous venovenous hemofiltration. Pediatric nephrology (Berlin, Germany) 1990. link 69 Blatz S, Paes B, Steele B. Peritoneal dialysis in the neonate. Neonatal network : NN 1990. link 70 Beck LH. Perioperative renal, fluid, and electrolyte management. Clinics in geriatric medicine 1990. link 71 Blake PG, Ryan F. Rhabdomyolysis and acute renal failure after terbutaline overdose. Nephron 1989. link 72 Menzies DG, Campbell IW, Winney RJ. Leptospira icterohaemorrhagiae infection presenting as acute renal failure. Scottish medical journal 1989. link 73 Watkinson GE. Chasing the bucket: a nursing view of continuous arterio-venous haemofiltration/dialysis. Journal of the Royal Naval Medical Service 1989. link 74 Safirstein R, Zelent AZ, Price PM. Reduced renal prepro-epidermal growth factor mRNA and decreased EGF excretion in ARF. Kidney international 1989. link 75 Zwaveling JH, Meulenbelt J, van Xanten NH, Hené RJ. Renal failure associated with the use of dextran-40. The Netherlands journal of medicine 1989. link 76 Davenport A, Roberts NB. Amino acid losses during continuous high-flux hemofiltration in the critically ill patient. Critical care medicine 1989. link 77 Beraud JJ, Calvet B, Durand A, Mimran A. 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    Original source

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