Pregnancy-related acute kidney injury: An analysis of 165 cases

Abstract

Pregnancy-related acute kidney injury (PRAKI) contributes to 3–7% of overall acute kidney injury (AKI) cases in Indian subcontinent. The aim of this study was to determine the outcomes of PRAKI and risk factors associated with renal injury and maternal mortality. One hundred and sixty-five patients with PRAKI, seen at M. S. Ramaiah Medical College between 2005 and 2014, were included in this, observational study. AKI was analyzed in terms of maximal stage of renal injury attained as per Risk, Injury, Failure, Loss of function, and End-stage renal disease (RIFLE) criteria. Outcomes included requirement for renal replacement therapy (RRT), maternal, and fetal mortality. Incidence of PRAKI was 1.56%, and the mean age of the study population was 25 years. Fifty percent of the patients were diagnosed with PRAKI during their first pregnancy. PRAKI was observed most commonly in the postpartum period (60%), followed by third trimester (32%); as per RIFLE criteria, failure was seen in 36% and injury in 34%. Thirty percent of cases required RRT. Sepsis (59%), pre-eclampsia, and eclampsia (56%) were the leading causes of PRAKI, while sepsis was the leading cause of maternal mortality. Maternal and fetal mortality were 20% and 22%, respectively. In univariate analysis, shock, hemorrhage requiring transfusion of >5 units packed red blood cells, oliguria, and “Loss” category of RIFLE were significantly associated with mortality. Majority of the patients (57%) required Intensive Care Unit care with a mean duration of admission at 7.3 days, and 75% was diagnosed with AKI at the time of admission. We report the lowest incidence of PRAKI in contemporary Indian literature. PRAKI was associated with high maternal and fetal mortality, with sepsis being the leading cause. No association was noted between mortality and initial stages of RIFLE criteria.

Etiology and Short term Outcome of Acute Kidney Injury (AKI) in Hospitalized Patients : A Single Center Study

“…According to this study the common causes of pregnancy related AKI were Sepsis (59%), pre-eclampsia, and eclampsia (56%). 6 Huang C et al reported 0.81% incidence of AKI during pregnancy with about 17% women with pre-eclampsia/eclampsia and 60% women with HELLP syndrome developing AKI. 7 Another study done in Canada over a period of 15 years concluded that AKI is a rare complication of pregnancy.…”

“…One study showed Maternal and fetal mortality were 20% and 22% respectively and sepsis was the leading cause of maternal mortality. 6 Mortality rate may be as high as 58%, when associated with pancreatistis. 9 However, as we have a limited number of cases with pregnancy and pancreatitis associated AKI we are unable to make a conclusion on these findings.…”

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

“…12 The lesser incidence of this problem is due to the improvement in antenatal care and the reduction of septic abortion due to its legalisation. 1,13,14 Socioeconomic factors contributing to PRAKI in the developing countries are mainly due to poverty, poor obstetrics care, lack of proper healthcare facilities and awareness of the condition, delayed referral process, multiparity, and the increasing population number. 15 Some studies summarized that the incidence of PRAKI was 1.0% to 2.8% in developed nations versus 4%-26% in developing countries.…”

“…15 Some studies summarized that the incidence of PRAKI was 1.0% to 2.8% in developed nations versus 4%-26% in developing countries. 1,2,[12][13][14][15] A study from India revealed a decrease in PRAKI incidence from 22% between 1965 and 1974 to 9% between 1981 and 1986,which was the result of better obstetrical care and increased availability of medical facilities. 16 Definitions and criteria RIFLE: Increase in SCr X 1.5 or GFR decrease >25%.…”

“…In pregnancy, acute renal injury usually occurs in women with previously healthy kidneys, but it can complicate the course of patients with pre-existing renal disease. 1 The incidence has declined due to improvements in reproductive health and perinatal care but it is still associated with significant perinatal mortality and maternal morbidity. 2…”