Renal complications

Acute renal failure occurs in approximately 5 per cent of women with eclampsia (Sibai 1990; D.oyglas...┬žD.d Redman 1994). Regular monitoring of urea, creatinine, and potassium is necessary, particularly if the patient is oliguric (urine output below 100 ml in 4 h). Optimizing ventricular preload is vital in women with oliguria. In most cases this can be achieved without recourse to pulmonary artery catheterization, but pulmonary artery wedge pressure monitoring may be particularly helpful if there is coexistent pulmonary edema. Low-dose dopamine (1-5 g/kg/min) may improve urine output in euvolemic pre-eclamptic women with oliguria. Once renal failure is established, fluid input should be restricted (urine output in preceding hour plus 30 ml/h). The majority of women have reversible acute tubular necrosis ( SibaieLa/

1990). Dialysis is required in about 50 per cent of cases, with the average number of dialysis procedures being 1.9 and the average duration of oliguria-anuria being 4.6 days (Sibai 1990; Sibai,. ..eta/ 1990).

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