Acute Kidney Injury in Pregnancy—Current Status

Acharya, Anjali; Santos, Jolina; Linde, Brian; Anis, Kisra

doi:10.1053/j.ackd.2013.02.002

Cited by 48 publications

(44 citation statements)

References 59 publications

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“…It is estimated that AKI occur in 1 out of 10,000-20,000 pregnancies in developed countries. 8,9 In the present study, the main causes of admission were pregnancy-associated hypertensive syndromes (more than half of cases), which is in accordance with previous studies showing that these are the main complications of pregnancy. The main causes of AKI in obstetric patients are hypertensive disorders, Creatinine (mg/dL) admission 1.6 ± 0.9 0.6 ± 0.1 < 0.001…”

Section: Discussionsupporting

confidence: 92%

“…AKI in critically ill patients has a prevalence varying from 20 to 30%, and dialysis is required in around 60% of cases. 7,8 In pregnancy, AKI is still not well studied, and its determinant factors should be better investigated. It is estimated that AKI occur in 1 out of 10,000-20,000 pregnancies in developed countries.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…However, acute renal ischemia is still major risk associated with severe pre-eclampsia and Haemorrhage, other factors being HELLP syndrome, abruption placentae, septicemia, acute fatty liver of pregnancy, severe hyperemesis gravidarum. 12 In present case, unattended massive post caesarean Haemorrhage resulting in fluid unresponsive hypotension, ACS and septicemia caused PR-AKI.…”

mentioning

confidence: 61%

Neglected obstetric haemorrhage leading to acute kidney injury

Verma¹,

Dogra²,

Sinha³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Pregnancy related acute kidney injury takes substantial share of acute kidney injury (AKI) in India, with obstetrical haemorrhage having high morbidity and mortality. A young female had neglected obstetric haemorrhage (unrecognized intrauterine and massive intraperitoneal bleeding post caesarean, due to uterine trauma and atony) and dangerous intra-abdominal hypertension with exsanguination eventually leading to shock, multifactorial AKI, metabolic acidosis, and hyperkalemia. Intensive and aggressive management with subtotal hysterectomy, inotropes, fluid management, mechanical ventilation, tracheostomy, and hemodialysis changed the outcome. Despite odds against, neglected obstetric haemorrhage with complicated AKI, was managed successfully by emergency hysterectomy, aggressive intervention for AKI with intensive fluid, ventilatory management and daily hemodialysis. Timely identification and aggressive management of this condition and complications is pivotal in preventing complications, morbidity, and maternal mortality.

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“…In Canada, obstetric acute renal failure increased significantly, from 1.6 per 10 000 deliveries in 2003 to 2.3 per 10 000 deliveries in 2007, whereas the rate in the United States increased from 2.3 in 1998 to 4.5 per 10 000 deliveries in 2008 6. This increase is an alarming sign, because obstetric acute renal failure is associated with maternal morbidity as well as fatality rate corresponding to 2.9% 1. Major risk factors for obstetric acute renal failure includes chronic hypertensive disease, pre-eclampsia, postpartum haemorrhage, ante partum haemorrhage, sepsis, and other infections 7.…”

Section: Introductionmentioning

confidence: 99%

Acute renal morbidities with obstetrical emergencies: An important women health issue

et al. 2017

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Objective:To observe the impact of acute renal morbidities with obstetrical emergencies on maternal health.Methods:In this study pregnant women between 28-40 weeks gestational period and delivered women in their puerperal period up to 42 days after delivery having acute renal problems associated with obstetrical emergencies were included. Pregnant and delivered women with obstetrical emergencies and associated other morbidities were excluded. These women were registered on the predesigned proforma after taking written informed consent and taking approval from institutional ethic research committee. The data was collected and analyzed on SPSS version 21.Result:Out of these 196 total registered women, majority of these women 81(41.32%) were between 21-30 years of age and multiparous women with parity four and above were 83(42.34%). Commonest presenting symptoms were generalized oedema 123(62.75%) and oligouria 92(46.93%). Frequent obstetrical emergencies observed were pre-eclampsia 53(27.04%), post partum haemorrhage 48(24.48%) and ante partum haemorrhage 36(18.36%) women. The complete recovery was observed in 86(43.87%) women, while mortality was seen in 56(28.57%) women.Conclusion:Renal morbidities were more frequently observed in obstetrical emergencies leading to high morbidity and mortality rate.

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Acute Kidney Injury in Pregnancy—Current Status

Cited by 48 publications

References 59 publications

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

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

Neglected obstetric haemorrhage leading to acute kidney injury

Acute renal morbidities with obstetrical emergencies: An important women health issue

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