Study on Incidence of Pregnancy-related Acute Kidney Injury and Its Associated Risk Factors and Outcomes: In Preponderant Tribal State of India.

Abstract

Background: Pregnancy-related acute kidney injury (PRAKI) may occur due to various causes from conception to puerperium. This study was undertaken to determine the incidence and associated risk factors and evaluate fetomaternal outcomes in PRAKI at tertiary care institution.

Materials and methods: A prospective longitudinal study was conducted with enrollment of pregnant females with PRAKI, ≥28 weeks, and up to 7 days of puerperium, diagnosed as per the Kidney Disease Improving Global Outcomes (KDIGO) criteria - serum creatinine >1.3 mg/dl at admission or increased by 0.3 mg/dL within 48 h or >1.5 times within 7 days or urine output <0.5 ml/kg/h. A detailed history including sociodemographic factors, obstetric history, and underlying medical disorders with primary cause and obstetric precipitating factors of PRAKI was noted. The sample size was 184 patients and followed up with serial renal function test, serum electrolytes, input/urine output monitoring, and dialysis, on nephrologist advice. Complete renal recovery was considered if serum creatinine <1.3 mg/dl at discharge.

Results: In the present study, the incidence of PRAKI was 3.16%, the mean age was 25.36 ± 5.13 years, and 76.08% of patients were antenatal, mostly primigravida. Primary causes were hypertension (57.06%), hemorrhage (20.65%), multiorgan failure (MOF), sepsis, and other causes. Obstetric complications which precipitate PRAKI were eclampsia (antepartum [52.38%], severe preeclampsia [44.77%], and postpartum [2.86%]), hemorrhage (antepartum [28.59%] and postpartum [23.68%]), hemolysis, elevated liver enzymes, and low platelet count syndrome (3.8%), and acute fatty liver of pregnancy (2.71%). The mean serum creatinine (mg/dL) at admission, after 48 h, and at discharge were 1.92 ± 0.87, 2.69 ± 1.33, and 1.09 ± 0.32, respectively (P = 0.0001). The mean blood urea (mg/dL) at admission and at discharge were 83.9 ± 30.42 and 37.2 ± 7.12, respectively (P = 0.0001). Hemodialysis was performed in 42 (22.83%) patients; 142 patients (77.17%) were managed conservatively. Complete recovery in 137 (74.46%), 19 (10.33%) maternal mortality, 5 (11.9%) patients progressed to chronic kidney disease, median hospital stay 10 days, intensive care unit (ICU) stay 8 days (P = 0.0001). Live birth, intrauterine death, and neonatal ICU admission were in 128 (69.57%), 56 (30.43%), and 42 (32.81%) patients, respectively.

Conclusion: Proper antenatal care, timely referral, and early detection and management of PRAKI may minimize fetomaternal morbidity and mortality.