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Background  Even in developed countries, severe specific pregnancy complications may occur in the immediate  postpartum  period and require admission to the ICU. The characteristics and risk factors of acute renal failure (ARF) induced by these complications and their treatments are not well known.    Methods  We performed a retrospective multicenter study in three intensive care departments linked to level III maternity wards in the north of France. All patients admitted to ICU for  postpartum  complications over a 5-year period (2008 to 2012) were included. Clinical and biological data, delivery characteristics, type of complications, and treatments were compared by univariate and multivariate analyses according to the occurrence and severity of ARF.    Results  One hundred eighty-two patients admitted to ICU for  postpartum  complications were included in the study. Sixty-eight patients (37%) developed an ARF: 49 with a low or medium severity and 19 with a severe ARF requiring renal replacement therapy. Hemolysis, elevated liver enzyme, and low platelet count (HELLP) syndrome on its own ( p  = 0.047) or combined with  postpartum  haemorrhage ( p  = 0.003), previous treatment by hyperoncotic albumin infusion ( p  = 0.001) and blockade of fibrinolysis by tranexamic acid ( p  = 0.03), was associated with secondary ARF. By multivariate analysis, the only independent factors were the association of HELLP syndrome with  postpartum  haemorrhage and the use of hyperoncotic albumin infusion.    Conclusions  HELLP syndrome associated with  postpartum  haemorrhage induces a high risk of ARF in the complicated  postpartum  setting. A particular attention should be given to treatments that could worsen the kidney function in that situation.

Postpartum acute renal failure: a multicenter study of risk factors in patients admitted to ICU