Acute renal failure and pregnancy: a seventeen-year experience of a Tunisian intensive care unit

Bouaziz, Mounir; Chaari, Anis; Turki, Olfa; Dammak, Hassen; Chelly, Hédi; Ammar, Rania; Nasri, Abdennour; Algia, Najla Ben; Bahloul, Mabrouk; Hamida, Chokri Ben

doi:10.3109/0886022x.2013.819767

Cited by 19 publications

(14 citation statements)

References 18 publications

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“…The diagnosis and treatment of AKI occurring during pregnancy, known as pregnancy-related AKI (PR-AKI), is a clinical challenge for obstetricians and nephrologists. The incidence and etiology of PR-AKI varies greatly between different regions (2)(3)(4)(5), and it has been reported that the incidence of PR-AKI in developed countries There is a high degree of heterogeneity in the definition of PR-AKI (2). Based on the existing literature, previously healthy pregnant women are considered to have developed AKI if they display an absolute increase in the serum creatinine (Scr) level of !…”

Section: Introductionmentioning

confidence: 99%

Pregnancy-related Acute Kidney Injury and a Review of the Literature in China

et al. 2015

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Objective To determine the incidence, causes and prognosis of pregnancy-related acute kidney injury (PR-AKI) in Chinese women. Methods From July 2004 to February 2013, 18,589 women of Han ethnicity who attended the Obstetrics and Nephrology Department of our tertiary hospital were investigated, and individuals meeting the PR-AKI criteria were included in the analysis. The WanFang, Chinese Science Journal, Chinese Knowledge, MED-LINE, EMBASE and Cochrane library databases were searched, and literature describing PR-AKI diagnoses with Chinese women as study subjects and a sample size of ! 5 were included. Results The incidence of PR-AKI was 0.1183% (22/18,589). Hemorrhagic shock (31.8%) and preeclampsia (severe, 18.2%) were the two most common causes of PR-AKI. Twelve women recovered completely, six women displayed persistent proteinuria and four women had an increased serum creatinine level at discharge. There were no cases of death. Twenty women demonstrated adverse pregnancy outcomes (90.9%), including eight cases of stillbirth (36.4%). In our literature review, 29 of 4,076 articles were included, and the incidence of PR-AKI in China was found to range from 0.02% to 1.84%. Pregnancy hypertension (49.2%) and postpartum hemorrhage (13.8%) were found to be the most common causes of PR-AKI in China. The prognosis improved in 81.9% of the patients, the renal function deteriorated in 4.5% of the patients and 13.6% of the patients died. The rate of stillbirth was 27.0%. Conclusion The maternal condition after active treatment was good, whereas the pregnancy outcomes were generally poor. Although the incidence of PR-AKI was relatively low, this finding is noteworthy. Further studies are thus warranted to improve maternal-fetal outcomes.

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Section: Introductionmentioning

confidence: 99%

Pregnancy-related Acute Kidney Injury and a Review of the Literature in China

et al. 2015

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“…In the present study, mortality among AKI patients was 20.6%, significantly higher than in those without this complication. Bouaziz et al 26 have also found a higher mortality among critically ill patients with AKI in comparison with those without AKI (9.3% vs. 1.7%, p < 0.001).…”

Section: Discussionmentioning

confidence: 91%

“…23 These laboratory abnormalities are probably associated with liver disorders, coagulation disturbances and HELLP syndrome. 2,8,[24][25][26][27] Regarding treatment, the use of vasoactive drugs, antibiotics, diuretics and mechanical ventilation were more frequent among AKI patients, which reflect the clinical severity of these patients. Mechanical ventilation and use of vasoactive drugs are associated with maternal mortality according to previous studies.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury in critically ill obstetric patients: a cross-sectional study in an intensive care unit in Northeast Brazil

Silva¹,

Saintrain²,

Castelo³

et al. 2017

Jornal Brasileiro De Nefrologia

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Lesão renal aguda em pacientes obstétricas gravemente doentes: um estudo transversal em uma unidade de terapia intensiva do nordeste do Brasil Introdução: A lesão renal aguda (LRA) é uma complicação ainda pouco estudada no contexto das pacientes obstétricas, que está associada com aumento da mortalidade. Objetivo: Investigar a frequência e os fatores de risco da LRA entre pacientes obstétricas. Métodos: Foi realizado estudo transversal com todas as pacientes admitidas em uma unidade de terapia intensiva (UTI) devido a complicações obstétricas em Fortaleza, Brasil, no período de janeiro de 2012 a dezembro de 2014. LRA foi definida de acordo com o critério AKIN. Resultados: Foram incluídas 389 pacientes, com idade entre 13 e 45 anos. As principais causas de admissão na UTI foram síndromes hipertensivas da gestação (54,5%), hemorragia e choque hemorrágico (12,3%), cardiopatias (9,0%), insuficiência respiratória (8,2%) e sepse (5,4%). LRA foi encontrada em 92 casos (24%), e esta foi a complicação mais frequente. A mortalidade geral foi de 7,5%, e a mortalidade por LRA foi de 21% (p = 0,0007). Na análise multivariada, os fatores de risco para LRA foram parto cesariano (IC 95% = 0,23-0,85, p = 0,01) e plaquetopenia (IC 95% = 1,50-4,36, p = 0,001). LRA foi um fator de risco independente para óbito (OR = 6,64, IC 95% = 3,11-14,15, p < 0,001). Conclusão: LRA foi a complicação mais frequente em pacientes obstétricas gravemente doentes e esteve associada com aumento da mortalidade. A maioria dos casos esteve associada às síndromes hipertensivas da gravidez, que são complicações passíveis de tratamento durante o pré-natal. ResumoPalavras-chave: gravidez; Insuficiência renal; mortalidade; unidades de terapia intensiva. Introduction: Acute kidney injury (AKI)is a complication still poorly studied in the setting of obstetric patients, which is associated with increased mortality. Objective: The aim of this study was to investigate the frequency and risk factors of AKI among critically ill obstetric patients. Methods: A cross-sectional study was conducted with all patients admitted to an intensive care unit (ICU) due to obstetric complications, in Fortaleza, Brazil, in the period between January 2012 and December 2014. AKI was defined according to AKIN criteria. Results: A total of 389 patients were included, aged between 13 and 45 years. The main causes of ICU admission were pregnancy-related hypertensive syndromes (54.5%), hemorrhage and hemorrhagic shock (12.3%), heart diseases (9.0%), respiratory insufficiency (8.2%) and sepsis (5.4%). AKI was found in 92 cases (24%), and this was the most frequent complication. General mortality was 7.5%, and mortality due to AKI was 21% (p = 0.0007). In the multivariate analysis, risk factors for AKI were cesarian delivery (95% CI = 0.23-0.85, p = 0.01) and thrombocythopenia (95% CI = 1.50-4.36, p = 0.001). AKI was an independent risk factor for death (OR = 6.64, 95% CI = 3.11-14.15, p < 0.001). Conclusion: AKI was the main complication among critically ill obstetric patients and it was a...

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“…In a prospective observational study in India, Gopalakrishnan et al reported preeclampsia as one of the causes of renal impairment in pregnancy [22]. In another retrospective study in Tunisia, Bouaziz et al [23] reported preeclampsia as the leading cause of renal impairment in pregnancy. While Peng [24] in a retrospective study conducted in Beijing, suggested both GH and PE as the primary cause of renal disease.…”

Section: Discussionmentioning

confidence: 99%

CKD-EPI is a Better Tool for Detecting Renal Dysfunction in Hypertensive Pregnancy: A Case-Control Study in Ghana

Fondjo¹,

Wkba²,

Sakyi³

et al. 2018

Vasc Med Surg

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BackgroundPregnancy-Induced Hypertension (PIH) is a universal problem and its global incidence is estimated between 5-14% of all pregnancies [1,2]. It is one of the major causes of pregnancy-related maternal deaths in the United States [3]. In Ghana, PIH contributes 40% of all maternal deaths [4] and one of the commonest pregnancy related complication encountered in Ghanaian hospitals.Pregnancy-Induced Hypertension is the main cause of renal impairment especially acute kidney injury in late pregnancy, with reported incidence of between 2% and 11.3% in preeclampsia and eclampsia patients [5,6]. Chronic kidney disease (CKD) is a common complication of hypertensive patients in Ghana, with a prevalence ranging between 22%-46.9% among the general population [7,8]. Kidney disease and preeclampsia however, are caused by similar factors; both disorders have been linked to hypertension, obesity, insulin resistance and endothelial dysfunction [9][10][11][12][13][14][15].A strong correlation exists between the incidence of preeclampsia and later incidence of kidney disease; moreover, preeclampsia further increases the risk for developing End-Stage Renal Disease (ESRD) [16]. Screening for renal impairment in pregnant women is not performed routinely during antenatal visits as such there is scanty information on this condition in these categories of women.Renal equations have been widely accepted for use in the general population to offset the challenges associated with the use of the collection of 24-hour urine for the calculation of creatinine clearance.However, the use of these equations in pregnant women still requires validation from large sample size and across different populations.This study thus, assessed renal function in women presenting with hypertensive pregnancy using renal equations, which eliminates the cumbersome nature of requesting for 24-hour urine, with the aim of providing preliminary data that could influence the early diagnosis and management of CKD in women presenting with hypertensive pregnancy in Ghana and to encourage the adoption of these equations for routine renal assessment in women with hypertensive pregnancy. Materials and Methods Study design and settingThis Hospital-based case-control study was conducted at the Abstract Background: Pregnant women with hypertension are at an increased risk of renal impairment. This study assessed the use of CKD-EPI and 4v-MDRD for early diagnosis of renal impairment in pregnant women with hypertension.

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Acute renal failure and pregnancy: a seventeen-year experience of a Tunisian intensive care unit

Cited by 19 publications

References 18 publications

Pregnancy-related Acute Kidney Injury and a Review of the Literature in China

Pregnancy-related Acute Kidney Injury and a Review of the Literature in China

Acute kidney injury in critically ill obstetric patients: a cross-sectional study in an intensive care unit in Northeast Brazil

CKD-EPI is a Better Tool for Detecting Renal Dysfunction in Hypertensive Pregnancy: A Case-Control Study in Ghana

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