Acute kidney injury in obstetrics: a five-year study in a tertiary centre

Abstract

Background: Pregnancy Related Acute Kidney Injury (PRAKI) is a major cause of maternal and foetal morbidity and mortality in developing countries. The incidence has declined due to improvements in reproductive health but it is still associated with significant perinatal mortality and maternal morbidity. It may be due to decrease in renal perfusion or ischemic tubular necrosis from a variety of conditions encountered during pregnancy. Our study aims at determining the predisposing factors and causes of AKI during pregnancy and its impact on maternal and foetal outcome.Methods: A retrospective cohort study over a period of 5 years was conducted on pregnant women with AKI as per inclusion and exclusion criteria. The detailed history, events, mode of delivery, cause leading to AKI, management, hospital stay, maternal and foetal outcome were studied in detail and evaluated. These patients were classified according to RIFLE criteria and were followed up for hospital stay and residual morbidities.Results: The incidence of PRAKI in the study was 0.07% (36 out of 50,735 deliveries) and among obstetric ICU patients, it was 6.8%. Most of the majority of the cases were unbooked (66.7%) and multipara (61.1%). Maternal morbidity was seen in 66.7% and mortality was 27.8%. Poor foetal outcome was seen in 44.4%.Conclusions: Haemorrhage is the most common cause of PRAKI, followed by toxaemia of pregnancy and sepsis. Early detection and meticulous management of haemorrhage, hypertension and sepsis reduce the incidence of PRAKI and associated maternal mortality.

Role of renal replacement therapy in pregnancy related acute kidney injury and its outcome

“…Most of the patients in our study were multipara (49.3%) and in stage III AKI 53.0% were multipara, other authors reported PRAKI more common in multipara 62%,[ 11 ] 61.1%,[ 12 ] and 79.6%[ 13 ] respectively, while two studies reported PRAKI more common in primipara (52%). [ 14 15 ]…”

“…Other authors concluded, late referral from PHC was one of the reason of poor pregnancy outcome in their study. [ 10 12 ] One study reported that out of 40 patients with sepsis AKI, 34 (85%) were referred from primary care centres (PHC). [ 20 ]…”

Acute Renal Problems Still a Great Challenge in Obstetrics

“…It is a serious obstetric complication associated with severe foetomaternal mortality and morbidity [3]. The incidence has declined due to improvements in reproductive health but it is still correlated with significant perinatal mortality and maternal morbidity [4]. It may be due to ischemic tubular necrosis or decline in renal perfusion from various conditions encountered during pregnancy [4].…”

“…The incidence has declined due to improvements in reproductive health but it is still correlated with significant perinatal mortality and maternal morbidity [4]. It may be due to ischemic tubular necrosis or decline in renal perfusion from various conditions encountered during pregnancy [4]. Major PRAKI factors involving hypertensive conditions during pregnancy, sepsis, obstetric hemorrhage, acute fatty liver and thrombotic microangiopathy during pregnancy, [5] and freshly reported 10.55% incidence of postpartum AKI (PPAKI) along with sepsis and haemorrhage being the most common etiologies [4,6].…”

“…It may be due to ischemic tubular necrosis or decline in renal perfusion from various conditions encountered during pregnancy [4]. Major PRAKI factors involving hypertensive conditions during pregnancy, sepsis, obstetric hemorrhage, acute fatty liver and thrombotic microangiopathy during pregnancy, [5] and freshly reported 10.55% incidence of postpartum AKI (PPAKI) along with sepsis and haemorrhage being the most common etiologies [4,6]. Acute renal failure poses a high risk for bilateral cortical necrosis of kidney in pregnancy and thus of chronic kidney dysfunction [7].…”