Pregnancy-related Acute Kidney Injury

Abstract

Aim: Acute kidney injury (AKI) is a rapid loss of kidney function. The proposed diagnostic criterion for AKI is an abrupt (within 48 hours) reduction in kidney function defined as an absolute increase in serum creatinine (level of >0.3 mg/dL) or a percentage increase in serum creatinine level of more than 50% (1.5 fold from baseline) or reduction in urine output (documented oliguria of less than 0.5 mL/kg per hour for more than 6 hours). The aim of this study is to determine the clinical spectrum of pregnancy-related AKI and the maternal outcome. Materials and methods: This is a descriptive study conducted in the Department of Obstetrics and Gynaecology from January to December 2015. Patients admitted with pregnancy-related AKI kidney injury were enrolled. The exclusion criteria were evidence of renal disease, hypertension, or diabetes prior to pregnancy, renal stone disease, renal scarring, or small size kidneys on ultrasonography (USG). Acute kidney injury was diagnosed according to the standard definition. The maternal outcome was noted in terms of complete recovery, partial recovery, or irreversible renal failure. Results: Twenty-eight patients were admitted with AKI. The mean age was 26.11 ± 6.2 years. One patient had antenatal checkup done at BP Koirala Institute of Health Sciences (BPKIHS). Acute kidney injury was diagnosed in the postpartum period in 24 (85.71%) patients. Fifteen (62.5%) patients had cesarean section and 9 (37.5%) had vaginal delivery. Out of 24 patients, 14 (58.3%) had delivered at BPKIHS and 10 (41.66%) at other health facilities. The most common diagnosis was hypertension complicating pregnancy (42.9%). Ten (35.7%) patients required dialysis. Blood transfusion was required in 18 (64.3%) patients. Ten (35.7%) patients required admission in the maternal intensive care unit (ICU). Complete recovery was seen in 25 (89.3%) patients and 3 (10.7%) patients expired. Conclusion: Pregnancy-related AKI can be prevented by improving the existing healthcare facilities as well as increasing public health awareness.

Pregnancy-related Acute Kidney Injury in Public Hospital in South India: Changing Trends

“…18 In a study from Nigeria the most common cause In a study from Bangladesh done from 2007 to 2008, PRAKI was seen in 21.6%. 16 A study from Pakistan reported PRAKI in 30%. 18 Pregnancyrelated acute kidney injury in China was reported to range from 0.2 to 1.8%.…”

“…6,[8][9][10][11][12][13][14][15] Pregnancy-related acute kidney injury is also common in other Asian countries including Nepal, Pakistan, and Bangladesh. [16][17][18][19] of PRAKI was obstetric hemorrhage in 50%, while sepsis (21.9%) and eclampsia (18.8%) were less common. There were no patients with PRAKI due to AFLP in our series or in any other study from India.…”