Pregnancy Related Acute Kidney Injury; Our Experience at Tertiary Level Hospital

Parween, Sadia; Sinha, Archana; Harshvardhan, Harshvardhan; Kumari, Smita; Prasad, Dipali; Goel, Neeru

doi:10.21276/ijcmr.2018.5.4.1

Cited by 5 publications

(6 citation statements)

References 8 publications

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“…This was near the findings of (Parween et al) (80%) but was higher than the reported 61.53% cases observed by (Goplani et al), 50% as observed by (Prakash et al) and 44.4% observed by (Kute et al). [10][11][12][13] A study from South India showed that 31.8% of the patients suffering from sepsis had expired, which was higher than that observed in our study (15.9%). 14 In our study, out of the total patients who had severe anaemia, 45.4% had improved renal function, 36.3% had no recovery of renal function and 18.1% expired, whereas (Kute et al) noted that 45% recovered, 20% had no recovery of renal function and as high as 35% expired out of the total patients having severe anaemia.…”

Section: Discussioncontrasting

confidence: 78%

“…12 A number of recent Indian studies showed similar results (52.6% recovery, 21% progression to CKD and 13.15% maternal mortality), 64.7% recovery. 7,13 (Kute et al) found a similar maternal outcome (52.64% recovery, 15.78% maternal mortality and 26.31% had no recovery of renal function). 11 A similar study from India showed a higher renal recovery rate (89.4%), lower maternal mortality (6.1%) and a lower progression to CKD (4.6%), whereas a study from Pakistan showed a worse outcome 34.2% recovery, 24.4% maternal mortality.…”

Section: Discussionmentioning

confidence: 87%

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Maternal and foetal outcome of acute kidney injury in pregnancy single centre experience from North India

Saxena

Beg²,

Aslam³

et al. 2023

Int J Res Med Sci

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Background: The diagnosis and treatment of acute kidney injury in pregnancy is a challenge to the physician as various pathophysiological changes take place during pregnancy, variability of symptoms and occasionally overlapping laboratory and clinical features. The occurrences of feto-maternal mortality associated with it decreased in developing nations due to increased prenatal and postnatal care and improved medical facilities. This study was undertaken to provide insight into feto-maternal outcome in patients presenting with acute kidney injury (AKI) during pregnancy. Methods: This was an open label prospective hospital-based cohort study comprising patients admitted in obstetrics and nephrology wards, presenting with AKI and no known chronic illnesses prior to pregnancy. Following criteria were used to diagnose AKI during pregnancy: (a) Elevation of S. creatinine ≥ 1 mg/dl; (b) Oligo-anuria for ≥ 12 hours and (c) Need for RRT. 50 such cases were enrolled in the study. Results: Out of all patients enrolled, majority (60%) had improved renal function, 16% expired, and 24% had no recovery in renal function. Out of all patients taken for haemodialysis, 20% of patients had improved renal function, 20% expired and 60% had no recovery in renal function. Mean S. creatinine on 3 months follow-up in conservative group found-1.67±1.31 mg/dl. 60% pregnancies resulted in the birth of a live baby and rest resulted in foetal loss. Conclusions: In our study, it was found that acute kidney injury in pregnancy results in significant feto-maternal mortality and morbidity. Those patients, who had significant renal derangement and concomitant complications, had poorer outcome.

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Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 87%

Maternal and foetal outcome of acute kidney injury in pregnancy single centre experience from North India

Saxena

Beg²,

Aslam³

et al. 2023

Int J Res Med Sci

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“…22 In this study, sepsis (46.9%) was the most common cause of obstetric AKI which is similar to Parween et al (49.9%). 23 Most common presentation of PRAKI in our study was oliguria (87.5%) and edema (84.3%). In our study mean hemoglobin level were (7.8 ± 1.7) gm/dl and creatinine level were (573 ± 407) µmol/l.…”

Section: Discussionmentioning

confidence: 52%

Pregnancy Related Acute Kidney Injury: A Multicenter Prospective Observational Study From Bangladesh

et al. 2023

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Background: Acute kidney injury (AKI) is one of the most challenging and serious complications of pregnancy which imposes a heavy burden of maternal morbidity and mortality if its diagnosis and treatment are delayed. Objective: This prospective study intended to determine the frequency, etiology and outcomes of the patients of pregnancy related acute kidney injury (PRAKI) in different tertiary care hospitals in Bangladesh. Methods: This was a prospective study of patients with pregnancy related complications leading to acute kidney injury admitted in selected departments of different tertiary care hospitals in Bangladesh for a period of one year (October 2018 to September 2019). Patients were included in this study who were healthy previously and developed acute kidney injury (serum creatinine >70.72 mmol/l) due to pregnancy related complications. Recruited patients were monitored after 3 months with a view to exclude chronic kidney disease. Result: A total of 351 patients with pregnancy and puerperium were observed, of these patients studied, 34 (9.2%) had pregnancy-related AKI. In 32 patients who completed the study, the mean age was 27.2±6.2 years. There were more subjects belonging to the rural area (68.8%) and nineteen (59.4%) of patients were below primary level of education. Most of the study subjects from lower socioeconomic status (56.2%). Twenty-one (65.5%) patients were multigravida, and mean parity of the patients included in this study was 1.7±0.8. Nineteen (59.4%) patients did not receive any antenatal care. PRAKI occurred during the post-partum period in 53.2% of the cases, 21.9% in third trimester, and 24.9% in first and 2nd trimester. The most common cause of PRAKI in our study was sepsis, occurring in about 15 patients (46.9%). Most common presentation of PRAKI was oliguria (87.5%) and edema (84.3%). Mean hemoglobin level was 7.8 ±1.7 gm/dl and creatinine level was 573±407 μmol/l. A majority of the patients (81.25%) underwent hemodialysis, while others were treated with conservative management only. At the three-month follow-up, complete resolution of AKI was observed in 62.5% patients, progressed to CKD in 25% whereas mortality occurred in 12.5% patients. In univariate analysis, inappropriate antenatal care (p- 0.0018), low mean platelet count (p-0.00001), higher serum creatinine (p-0.00004), dialysis at presentation (p-0.0154), and septicemia (p-0.0487), have significant effect. Conclusion: Pregnancy related AKI is still a critical situation in developing countries and rare entity in developed countries. Maternal mortality has decreased but sepsis still accounts for majority of cases of PRAKI. Therefore, early diagnosis and treatment is the need of the hour. J Dhaka Med Coll. 2021; 29(1): 76-81

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“…Acute kidney injury (AKI) is a serious complication in critically ill patients and is associated with long-term development of chronic kidney disease (CKD) with increased hospitalization time, morbidity and mortality [1,2]. Chronic renal disease is progressively increasing in south Asian countries and the reason for this spread is multifactorial.…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury During Pregnancy and Puerperium

Taj¹,

Bakhtawar²,

Naqvi³

et al. 2022

PJMHS

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Background and Aim: Acute kidney injury (AKI) is a serious complication in perilous patients substantially related to long-term chronic kidney disease (CKD) with increased morbidity, hospital duration, and mortality. AKI during pregnancy is a life-threatening disease related to maternal and fetal loss contributing to 30% to 60% of mortality. Though a rare cases of AKI during pregnancy has been reported in previous studies. But the present study aimed to assess the acute kidney injury during pregnancy and puerperium. Methodology: This cross-sectional study was conducted on 205 pregnant or puerperium women with acute kidney injury or acute renal failure in the Department of Gynaecology and Obstetrics and Nephrology, Liaquat National Hospital, Karachi from January 2019 to December 2021. All the pregnant women of age 22 to 40 years with no prior co-morbidities were enrolled in this study. Patients with history of autoimmune disease, chronic kidney disease before pregnancy, higher level of serum creatinine, hypertension before gestation and renal stone diseases, renal scarring on ultrasonography or small size of the kidneys were all excluded. An informed consent was taken from all the patients. Patient’s detailed history, laboratory investigations, demographic details, and clinical presentation were recorded. Laboratory examination involve CBC and renal function tests. Each patient had a thorough obstetric examination. Hemodialysis was performed as per standard indications. Acute kidney injury was assessed. SPSS version 25 was used for data analysis. Results: The incidence of acute kidney injury in pregnant and puerperium women was 21.5% (n=44). The overall mean age was 31.42 ± 4.35 years. Mean parity was 3.2. During pregnancy, the most prevalent cause of acute kidney injury was pre-eclampsia with incidence rate of 28 (63.6%) followed by postpartum hemorrhage in 8 (18.2%). About 6 (13.6%) patients had regain renal function and discharged from the hospital. Maternal mortality was found in 2 (4.5%) cases. Of the remaining 161 pregnant women without AKI cases, the prevalence of postpartum hemorrhage, HELLP syndrome, pre-eclampsia/eclampsia, and pregnant fatty liver were 58 (36.02%), 17 (10.6%), 66 (41%), and 20 (12.4%) respectively. Apart from hemorrhagic shock and amniotic fluid embolism, maternal outcomes was good. No significant association was found between acute kidney injury and outcomes with 5% level of significance. Conclusion: The present study found a higher prevalence of acute kidney injury in pregnant women. Pre-eclampsia and postpartum hemorrhage was the prevalent causes for AKI in pregnant women. Postpartum hemorrhage and amniotic fluid embolism were the major causes for mortality of pregnant women with AKI. The mortality of pregnant women with AKI is mostly caused by postpartum hemorrhage and pre-eclampsia. Poor outcome might be predicted by renal therapy need in acute kidney injury. Further studies is required to be conducted in order to improve pregnancy associated AKI outcomes. Keywords: Acute kidney Injury, Pregnant women, Puerperium

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Pregnancy Related Acute Kidney Injury; Our Experience at Tertiary Level Hospital

Cited by 5 publications

References 8 publications

Maternal and foetal outcome of acute kidney injury in pregnancy single centre experience from North India

Maternal and foetal outcome of acute kidney injury in pregnancy single centre experience from North India

Pregnancy Related Acute Kidney Injury: A Multicenter Prospective Observational Study From Bangladesh

Acute Kidney Injury During Pregnancy and Puerperium

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