septic abortion and massive haemorrhage (traditionally caused by placental abruption, although any cause of hypovolaemia may be followed by renal failure). Other important causes include pyelonephritis, drug reactions (especially non-steroid anti-inflammatory drugs [NSAIDs]), acute fatty liver and incompatible blood transfusion. In most cases, ARF is caused by acute tubular necrosis, although cortical necrosis has been seen after abruption and pre-eclampsia. Problems are those of ARF generally, especially related to fluid balance and the apparently increased susceptibility of pregnant women to developing pulmonary oedema.
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