Study of Pregnancy related AKI in Egyptian patients: Incidence, Risk factors and Outcome

Abstract

Background Acute kidney injury (AKI) is a serious problem during pregnancy. Once occurred, it causes devastating maternal and fetal outcomes. In developed nations, the trend of pregnancy-related AKI (PRAKI) is on a decline due to the advances in obstetrics care and the legality of abortion. On the contrary, this situation remains a major health problem in the developing countries. Aim of the work in the present study, we determine the incidence, etiology and outcome of PRAKI in a sample of Egyptian patients. Methods Prospective observational study to determine the incidence, etiology and outcome of PRAKI was conducted over a period of one year from January to December 2017 at Ain Shams university obstetrics & gynecology hospital. Patients were enrolled in this study once PRAKI at antepartum as well as postpartum period was diagnosed according to the definition of KDIGO AKI guidelines diagnostic criteria Results During the period of the study a total of 13050 obstetric patients were admitted in Ain Shams university obstetrics & gynecology hospital. In total, 78 patients met the diagnostic criteria of PRAKI representing an incidence of 0.59% (78/13050). Pre-eclampsia & sepsis were the two most common causes of PRAKI, others were dehydration, postpartum hge, antepartum hge, UTI, proteinuria for investigation, SLE activity, DIC, TTP, Acute fatty liver of pregnancy, eclampsia, eclampsia complicated with HELLP syndrome, eclampsia with acute fatty liver of pregnancy, HUS, hyperemesis gravidarum, hypertensive emergency. Fifty five patients (70.5%) received conservative management. Hemodialysis was initiated in twelve patients (15.3%) based on standard indication (azotemia, oliguria volume overload, hyperkalemia and/or metabolic acidosis). Hemodialysis and plasma exchange was used for four patients (5.1%). Plasma exchange was indicated for seven patients. None of the patients received peritoneal dialysis or continuous renal replacement therapy. The ultimate evolution was good in 47 (60%) patients with complete recovery of the kidney function.14 women (17.9%) had an increased serum creatinine level at discharge for follow up at outpatient clinic. 6 patients (7.6%) had kept with advanced renal failure requiring hemodialysis. There were 11 cases of death, mortality rate was 14%. Conclusion AKI during pregnancy poses a challenge for physicians. In view of the multifaceted problems that potentially complicate pregnancy in women with AKI. Fortunately, with ongoing improvements in obstetrical care, multidisciplinary approaches comprising nephrologists, obstetricians and neonatologists maternal and perinatal mortality in this setting are largely avoidable. Therefore early recognition of signs and symptoms, close monitoring in high risk cases, early referral and a multidisciplinary team management could potentially prevent progression to higher stages of PRAKI and reduce morbidity and mortality.

Access to Nephrology Care for Pregnancy-Related Acute Kidney Injury in Low- and Lower-Middle-Income Countries: A Perspective

“… 14 , 15 , 16 One of the largest centers from Pakistan reported that 25.6% (n=1441) of patients who presented with AKI were experiencing pregnancy-related AKI in the period from 1990 to 2014. 17 Other countries like Egypt, 6 , 18 , 19 Nigeria 20 , 21 , 22 and DRC 23 have a few single center reports on the incidence and outcomes of pregnancy-related AKI; however, these do not provide the national burden of pregnancy-related AKI in each country.…”

“…Moreover, maternal and fetal mortality rates were very high. 6 , 18 , 19 In Pakistan, 1 study showed that the risk factors for pregnancy-related AKI included perinatal bleeding, placental abruption, intrauterine fetal death, sepsis, pre-eclampsia, and eclampsia. Other rare causes included surgical trauma, exposure to nephrotoxic antibiotics, and hemolysis with blood transfusion reaction.…”

“…In Egypt, most critically ill patients are treated in tertiary teaching hospitals; correspondingly, all the published studies were conducted at teaching hospitals where diagnostic and therapeutic facilities such as kidney biopsy, plasma exchange, and HD are relatively available. 6 , 18 , 19 Hemodialysis is the primary modality in Egypt; the use of PD is presently limited due to the high cost of the treatment, the need for highly trained health care providers, and the lack of a national program to promote PD. 45 Although there is no adequate data regarding the size of outpatient dialysis centers, it has been estimated that the number of dialysis machines exceeded 3000 in over 600 dialysis units in 2009.…”