A study of obstetric acute renal injury

Abstract

INTRODUCTIONAcute kidney injury is a clinical syndrome characterized by a sudden decline in glomerular filtration rate leading to decreased excretion of nitrogenous waste products like urea, creatinine and other uremic toxins.1 Obstetric AKI is usually caused by septic abortions in early pregnancy and by pregnancy toxemia, antepartum hemorrhage, postpartum hemorrhage and HELLP syndrome in late pregnancy.2,3 Its incidence has decreased in the developed countries to only 1-2.8% due to better antenatal care and rare cases of septic abortion in these countries. 4,5 However, in the developing countries it is still frequent and the incidence is around 4.2-15%. 4 High incidence in developing countries is mainly due to limited inaccessibility of antenatal care and emergency obstetric healthcare facilities.6 Obstetric AKI may comprise up to 25% referrals to dialysis centers in these countries and is associated with high maternal and fetal mortality.7 Acute tubular necrosis (ATN) is the most common pathology with a good prognosis. 7,8 There is a high risk of bilateral renal cortical necrosis and consequently of chronic renal failure in these patients. It is an uncommon event and accounts for only 2% of all cases of AKI with obstetric complications being the most common etiology.3 This study was carried out with the objective of finding the factors leading to obstetric AKI and its outcome. ABSTRACTBackground: Acute renal or kidney injury (AKI) is a clinical syndrome characterized by a sudden decline in glomerular filtration rate leading to decreased excretion of nitrogenous waste products. It continues to be a common problem in developing countries. The aim of this study was to understand AKI characteristics in pregnancy and identify the factors related to its unfavorable outcome. Methods: This prospective study was conducted between January 2014 to December 2017. Out of 1057 patients delivered in our institute during this period, out of which 26 patients with Obstetric AKI were included in this study. Results: Incidence of obstetric AKI was 2.64 %. Their age varied from 19 to 34 years, with an average of 26.2 years. About 21(80.8%) patients had not received antenatal care. The main causes of AKI were obstetric hemorrhage (38.46%) and puerperal sepsis (15.38%). The outcome was favorable with complete renal function recovery in 55.76% patients. Two (7.69 %) patients became dialysis dependent. Maternal mortality was one (3.84%). Conclusions: Obstetric AKI is a critical situation in developing countries. Lack of antenatal care (80.8%) is a major contributing factor for obstetric-related complications leading to renal failure. Obstetric hemorrhage (38.46 %) is the most common cause of obstetric AKI. Late referral in 9 (34.61%), puerperal sepsis in three (33.33%), obstetric hemorrhage in three (33.33%) and combined sepsis and hemorrhage in two (27.77%) are the common contributing factors leading to its unfavorable outcomes as maternal morbidity and mortality. Hence, a multidisciplinary approach is warranted to prevent such an a...