A Clinical Study of Pregnancy-Associated Renal Insufficiency

Abstract

Background/Aim: This study aimed to explore the causes, incidence and outcome of renal insufficiency during pregnancy. Methods: All pregnant women admitted to our hospital from September 2004 to August 2007 were retrospectively screened for renal function. Patients were divided into 3 groups according to the serum creatinine (Scr) level (mild renal insufficiency: Scr 70–123 µmol/l; moderate: Scr 124–220 µmol/l; severe: Scr >221 µmol/l). Results: Seventy-five cases (2.51%) of renal insufficiency were identified. Twenty-two cases (0.73%) had evidence of chronic kidney disease before pregnancy. Compared to the moderate and severe groups, the mild group had the lowest blood pressure. In 29 recorded cases with multiple observations throughout pregnancy, the deterioration of renal function progressed during the course of pregnancy; on average, Scr changed from 177 ± 109 µmol/l in the early phase of pregnancy to 194 ± 149 µmol/l (p < 0.001) in the third trimester, and mean blood pressure increased from 97 ± 11 to 120 ± 19 mm Hg (p < 0.001). There were 37 cases with preeclampsia (49%). Fourteen cases showed a decrease in glomerular filtration rate (GFR) in the third trimester; 4 of these patients suffered a severe decrease in GFR (over 25%). The rate of obstetrical complications was high among pregnancies with renal impairment. Conclusion: Renal insufficiency associated with pregnancy is not rare, and renal function may deteriorate during the course of pregnancy.

Epidemiology of acute kidney injury in hospitalized pregnant women in China

“…The previous single-centered studies reported that the incidence of AKI ranged from 0.12–2.51% in pregnant women from China [8, 9, 17]. Notably, most of these studies identified the AKI event by using diagnostic codes, which might under-estimate the incidence of AKI [7, 24].…”

“…However, the burden and risk profile of pregnancy-related AKI in developed countries might be different from that in developing world [5, 7, 8]. The reported incidence of AKI during pregnancy in developing countries, such as India, and Pakistan ranged from 0.02 to 11.5% [9–17]. These studies were limited by small sample sizes, highly selected populations, and varying definitions of AKI those have not been validated in pregnancy [9–20].…”

Contribution of Dysfunction of Maternal Hemodynamics to Renal Impairment in Preeclampsia

“…This finding is consistent with other studies. Liu et al [3] and Wang et al [12] found that PE induced significant renal injury characterized by an elevation of 24 h urine total protein excretion and a reduction in GFR. Alsuwaida et al [13] reported that an estimated GFR ranging between 60 and 89 ml/min/1.73 m 2 was associated with significant maternal and fetal complications.…”

Acute renal failure during the pregnancy: a review on pathophysiology, risk factors and management

“…In a previous investigation on a Chinese population, 70.72 umol/L was applied as the cut-off value for abnormalities in pregnant women. Seventy-five cases (2.51%) of ARF were identified in 2988 adult pregnant women (23).…”