Acute kidney injury in obstetrics: Hospital-based cohort study

Abstract

Obstetric acute kidney injury (AKI) is a serious unsolved global health-care problem and is a significant contributor to the overall burden of AKI resulting in devastating maternal and foetal outcomes. We studied the characteristics of obstetric AKI and the factors related to its unfavourable outcome. A total of 110 patients developed AKI among 10,138 admission giving a frequency of 1.08%. The commonest risk factor was pre-eclampsia followed by haemorrhage and sepsis. Complete recovery of renal function occurred in 40.9%. However, 9.1% were left with end-stage renal disease. AKI due to sepsis, delayed referral and deranged renal function on admission was associated with unfavourable outcome. AKI in pregnancy merits special attention because it involves risk to two lives, mother and foetus. Early identification of risk factors coupled with timely and efficient management will result in reducing obstetric AKI and associated maternal morbidity and mortality

Pregnancy Related Acute Kidney Injury: A Single Tertiary Care Center Experience

“…Our study showed a high rate of complete recovery of patients with PR-AKI (72.2%). This was higher than the Indian study in which about 50% of cases showed complete recovery [3] , and comparable to the 70.6% rate that was reported in the meta-analysis [29] , and to the 62.5% rate reported in the Egyptian study [28] .…”

“…In our study, 10 cases (55.6%) needed dialysis while the rest of cases were managed without renal replacement therapy. This was higher than the Indian study in which only 26.4% of cases with PR-AKI needed dialysis [3] and comparable to the 55% rate that was reported in the meta-analysis including both hemodialysis and peritoneal dialysis [29] . The decision of dialysis was determined by nephrologist and ICU physician and followed the same indications in AKI that included presence of volume overload that is nonresponsive to diuretic therapy, presence of severe electrolyte and acid base abnormalities as persistent hyperkalemia refractory to medical treatment and presence of evident uremic manifestations as pericarditis or encephalopathy [24] .…”

“…In this study, preeclampsia was also the most common cause of PR-AKI, accounting for 44.54% of cases, which is comparable to the 50% incidence that was reported in our study. Obstetric hemorrhage, sepsis and AFLP accounted for 35.4%, 28%, and 11% of cases; respectively [3] . In a meta-analysis and systematic review that included 31 studies between 1980 and 2021, the most common cause of PR-AKI was preeclampsia with other less common causes included septic abortion, APH, PPH, and AFLP [29] .…”

“…Obstetric hemorrhage as a cause of PR-AKI accounted for only 16.7% in our cases and did not represent the leading cause of AKI in our study. In the developing countries, bleeding complications during pregnancy still represent a major cause of PR-AKI as evidenced from the Indian study where it accounts for 35.4% of all cases with PR-AKI [3] . One of the most important causes of obstetric hemorrhage in last decades is placenta accreta spectrum.…”

“…Despite much improvement in health care, this remained unsolved major public health care problem all over the world as more than 13 million people have AKI each year, the majority of them (about 85%) are resident in developing countries with low resources [2] . The AKI was considered in the past a reversible disease, but more extensive research had revealed that it may affect the future health and is linked to ongoing hypertension, cardiovascular diseases and even in some cases it may lead to permanent affection of kidney function known as chronic kidney disease (CKD) with its related mortality [2][3][4][5] .…”