Pregnancy related acute kidney injury: A single center experience from the Kashmir Valley

Methods:A hospital based prospective observational study was conducted in Tribhuvan University Teaching Hospital (TUTH) over a period of 18 months. All patients diagnosed with PRAKI were included in the study. Patient profiles in terms of age, parity, gestational age were studied along with time of occurrence of PRAKI, preceding event, etiology, management and maternal outcome. Descriptive and univariate analyses were conducted and qualitative variables were expressed as percentages while quantitative variables as means.Results: There were fifteen cases of PRAKI during the study period with incidence of 2.1 per 1000 deliveries. The average age was 25.23± 3.8 years and 9(60%) were primipara. Fourteen (93.3%) developed PRAKI in the postpartum period with 10(66.6%) cases following Lower Segment Caesarian Section (LSCS). The commonest etiology of PRAKI was severe preeclampsia/ Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP) syndrome and pregnancy hemorrhages each consisting 4(26.6%) cases. The stage of Acute Kidney Injury (AKI) according to RIFLE (Risk, Injury, Failure, Loss, ESRD-End Stage Renal Disease) criteria was as follows: risk in 1(6.6%), injury in 3(20%) and failure in 11(73.3%) cases. Hemodialysis was necessary in 12(80%) cases while 3 cases (20%) improved with medical management only. The average duration of hospital stay was 25.2±14.7 days and 7(46.6%) needed ICU admission. Twelve (80%) cases recovered completely while two patients were dialysis dependent at the time of evaluation. There was one death.Conclusions: PRAKI occurred mainly in the postpartum period with severe preeclampsia/HELLP syndrome and hemorrhages as the most common causes. It is associated with high maternal morbidity, prolonged hospital stay and even mortality. Multidisciplinary team management is essential.

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“…10,11 There was one (6.6%) maternal mortality in our study compared to 2.7% in the Moroccan study and 20% in the study by Najar et al 10,11 …”

contrasting

confidence: 39%

Pregnancy Related Acute Kidney Injury at a Tertiary Care Center in Nepal

Paudyal

Pradhan

Bista

et al. 2015

Nepal j. obstet. gynaecol.

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“…The identification of risk factors associated with AKI and its poor prognosis is required so that preventive and early diagnosis measures can be taken, aiming to reduce patients' mortality. Our findings were supported by Najar et al [38] who reported 15% who had KI was associated with preeclampsia and (12%) in Ansari et al [39] While a study of Gurrieri et al [17] observed that kidney injury was associated with preeclampsia in a substantial percentage (20.4 %) of patients as well. On the contrary, Hachim et al [40], Erdemoglu et al [41] and Arrayhani et al [31], Said et al, [42] and Suraj et al [43] found that pre-eclampsia/eclampsia was (33.3%).…”

Section: Discussionsupporting

confidence: 87%

The risk factors and outcome of early identified acute kidney injury among critically ill obstetric patients

El-Hafez

Mahjoub

Ahmad

2017

IJANS

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Background: Acute kidney injury (AKI) is one of the most challenging and serious complications of pregnancy and postpartum period that facing critical care nurses in Intensive Care Unit (ICU). Having a uniform standard for identifying and classifying AKI would enhance critical care nurses' ability to recognize these patients and leading to better outcomes. Objective: This work aimed to explore the risk factors and outcome of early identified acute kidney injury of critically obstetric patients in Obstetric ICU. Design. A descriptive cross sectional research design was used in this study. Participants: A total sample of 338 women admitted to Obstetric ICU at Woman Health Hospital, Assiut City, Egypt. Method: Three tools were used.Tool I was developed by the researcher and included demographic and obstetric history, lab parameters, complications and outcomes arising from AKI. The Sequential Organ Failure Assessment (SOFA) score as tool II to determine the extent of a patient's organ function or rate of failure. Measurement of serum creatinine and urine output were used to early identify AKI stages according to Acute Kidney Injury Network (AKIN) Criteria (tool III). Results: The prevalence of AKI among obstetric patients admitted to obstetric ICU was 10.1%; of them 52.9% needed renal replacement therapy and the mortality rate was 29.4%. Postpartum hemorrhage was the most common cause of AKI and its prevalence was 41.2%. It was also found that 74.5% of AKI patients developed complications. Conclusion: AKI complicated 10.1% of total admitted women to the OICU in the studied period. Postpartum hemorrhage represents the most prevalent risk factors with a highly significant SOFA score compared to other risk factors as sever preeclampsia, eclampsia, HEELP & APH with acute fatty liver.

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“…1 In study by Najar MS hemodialysis was given to 32.5%. 15 Total recovery of renal function found in 6/10 (60%), with complete recovery in 2/10 (20%) patients. The majority of remaining patients 4/10(40%) had partial recovery and did not require renal replacement therapy.…”

Section: Discussionmentioning

confidence: 96%