Renal pathology in maternal deaths: An autopsy study

A spectrum of renal pathology is observed during pregnancy, so our main objective was to study the gross pathology and microscopy of the kidney in cases of maternal death, and to establish a clinico-pathological correlation. This was a cross-sectional study of all medical autopsies performed on deaths related to pregnancy at our tertiary care hospital over a period of 7 years. In 166 autopsies, pathology was observed in 42 cases, and the kidneys were unremarkable in 124 cases. The most common renal pathology observed was acute tubular necrosis (22 cases), followed by acute pyelonephritis (7 cases), disseminated intravascular coagulation with fibrin thrombi (7 cases), diabetic nephropathy (3 cases), sickle cell anemia (1 case), tuberculosis kidney (1 case), and thrombotic microangiopathy (1 case). Renal pathology was observed in 25.3% of autopsies performed on maternal death, which contributed to a significant number of maternal mortalities and morbidities. The incidence of acute renal failure was 14.28% in our study. Apart from obstetric complications (e.g. antepartum hemorrhage, postpartum hemorrhage, pregnancy-induced hypertension), infections (e.g. pyelonephritis) were associated with septicemia, deranged renal function tests, and acute renal failure.