Acute kidney injury during pregnancy and puerperium: a retrospective study in a single center

Abstract

BackgroundAcute kidney injury (AKI) is rare in women during pregnancy and puerperium, however, it is related to increased morbidity and mortality rates.ObjectiveThe aim of this study was to investigate the incidence, characteristics, and outcomes of AKI during pregnancy and puerperium in a Chinese population.MethodsIn this study, pregnant women discharged from hospital between January 2008 and June 2015 were screened. AKI was defined if the level of serum creatitine >70.72umol/l in pregnant women without chronic kidney disease (CKD). Acute-on-CKD was defined as a 50% increase in the level of serum creatinine vs baseline in patients with pre-existed CKD.ResultsWe reported a high incidence (0.81%) of AKI during pregnancy and puerperium. Three hundred and forty-three cases of AKI during pregnancy and puerperium included 21 severe AKI cases and 21 cases with acute-on-CKD. Pre-eclampsia/eclampsia, and postpartum hemorrhage were the most frequent causes of AKI during pregnancy and puerperium. About 17% women with pre-eclampsia/eclampsia and 60% women with HELLP syndrome complicated with AKI. The maternal outcome was good except in the setting of amniotic fluid embolism or hemorrhagic shock, whereas the prenatal outcome was relatively poor. Among the 14 death cases, 7 cases received renal replacement therapy. Amniotic fluid embolism and postpartum hemorrhage were the major causes of death in pregnant women with AKI.ConclusionAKI during pregnancy and puerperium is not as rare as we thought. Pre-eclampsia/eclampsia is the most common cause of AKI during pregnancy and puerperium, however, the outcome of pre-eclampsia-related AKI is good. Amniotic fluid embolism and postpartum hemorrhage are the leading causes of maternal mortality. Severe AKI may predict poor outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0551-4) contains supplementary material, which is available to authorized users.

Acute Kidney Injury in Pregnancies Complicated With Preeclampsia or HELLP Syndrome

“…In one study, AKI in the setting of HELLP syndrome carried an 11.5% maternal mortality rate (80). In several study populations, all maternal deaths in HELLP syndrome patients occurred in women with AKI, and serum creatinine levels were independent risk factors for mortality suggesting that AKI increases the already high mortality rate for women with HELLP syndrome (29,80). Indeed this is thought to be true, as we have previously reported that in a study of women with HELLP syndrome, women with Class I HELLP (i.e., platelet levels <50,000 × 10 9 /L) had a significantly higher composite maternal mortality score (84); which upon additional analysis we found was associated with a higher risk for developing renal complications such as AKI (83).…”

“…Hypertensive disorders causing AKI can occur throughout the late second to third trimesters (27)(28)(29). As illustrated in Figure 2, the most commonly reported primary causes for PR-AKI are widespread, however these factors are often multifactorial, which can worsen the clinical scenario for the pregnant patient (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). PR-AKI of any etiology can be severe and in some cases can lead to ARF, or the need for renal transplantation, plasma exchange, dialysis or pharmacological treatment (3,44).…”

“…For example, women with preexisting renal disease are at an increased risk of preeclampsia (52), and therefore are at a higher risk of developing AKI. Preeclampsia when severe or when associated with HELLP syndrome can lead to ARF (8,19,20) and in the setting of HELLP syndrome alone, AKI has been reported to occur in 7-60% of patients (28,29,(79)(80)(81)(82). When PR-AKI occurs, it also increases the risk of other obstetric complications.…”

Acute renal failure during the pregnancy: a review on pathophysiology, risk factors and management

“…Postpartum hemorrhage is known as bleeding more than 500 mL within the first 24 hours following delivery (58). Occurring obstetric ARF in postpartum period is a specific entity and may be considered as a form of HUS (6).…”

A study of pregnancy related acute kidney injury and its outcome at a tertiary care centre, civil hospital, Ahmadabad, Gujarat, India

“…It currently affects 1 per 20,000 pregnancies. 6,7 Hence, it is essential to focus on the prevention, periodic evaluation of pregnant women and improvement in the care during the peripartum period to improve maternal and perinatal outcomes. Due to advances in contraception, legalizing abortion and more careful monitoring of the perinatal period, the incidence of PRAKI is on decreasing trend.…”