Acute renal failure in pregnancy.

ARF is becoming an increasingly rare complication of pregnancy in industrialized countries because of a decrease in illicit abortions, improved prenatal care, and better management of maternal complications potentially leading to ARF. Early recognition of ARF with prompt therapy of reversible causes and rapid delivery in untreatable cases has led to more favorable outcomes for both gravida and fetus. Clinicians should be alert for entities unique to pregnancy, e.g., concealed uterine hemorrhage in late gestation. Dialysis therapy, if needed, should be started early and performed frequently, with careful attention to avoiding sudden shifts in extracellular volume and hypotension, or bleeding complications.