Study of clinical profile and outcome in pregnancy related acute kidney injury
Keywords:Acute kidney injury, Fetuses, Pregnancy, Serum creatinine
Background: Acute kidney injury (AKI) is a clinical syndrome characterized by a sudden decrease in glomerular filtration rate leading to decreased excretion of nitrogenous waste like urea, creatinine and other uremic toxin. Even minor changes in serum creatinine are associated with increased in-patient mortality. To study various etiological factors responsible for AKI to do better management of condition for prevention of adverse effects on maternal and fatal outcome. To study outcome of disease in form of recovery, morbidity and mortality. To record maternal and foetal outcome.
Methods: A prospective, observational study of 50 patients conducted at department of obstetrics and gynaecology, Medical College Baroda and Sir Sayajirao General Hospital from the time period of 1 year.
Results: There was no significant association of initial serum creatinine with maternal outcome. However, there was significant association of last serum creatinine and Percentage Improvement in serum creatinine with maternal outcome as last serum creatinine was significantly lowest in completely recovered patients as compared to dead and discharged on request patients and percentage Improvement in serum creatinine was significantly high in completely recovered patients as compared to dead and discharged on request patients. There was no significant association of initial and last serum creatinine with fetal outcome; however, percentage improvement in serum creatinine was significantly high in alive fetuses as compared to aborted, dead and undelivered fetuses.
Conclusions: Pregnancy-related AKI is a common medical problem and understanding its association with various etiopathologies has significant impacts on maternal and fetal outcome.
Mehta RL, Kellum JA, Shah SV. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11: R31.
Stratta P, Besso L, Canavase C, Grill A, Todros T, Benedetto C, et al. Is pregnancy related acute renal failure a disappearing clinical entity? Ren Fail. 1996;18:575-84.
Makusidi AM, Liman HM, Yakubu A, Hassan M, Isah MD, Chijioke A. Hemodialysis among pregnancy related acute kidney injury patients: A single center experience in North Western Nigeria. Indian J Nephrol. 2016;26:340-2.
Okunola OO, Ayodele OE, Adekanle AD. Acute kidney injury requiring hemodialysis in the tropics. Saudi J Kidney Dis Transpl. 2012;23(6):1315-9.
Prakash J, Tripathi K, Malhotra V, Kumar O, Srivastava PK. Acute renal failure in eastern India. Nephrol Dial Transplant. 1995;10:2009-12.
Prakash J, Tripathi K, Pandey LK, Gadela SR, Usha. Renal cortical necrosis in pregnancy related acute renal failure. J Indian Med Assoc. 1996;94:227-9.
Selcuk NY, Tonbul HZ, San A, Odabas AR. Changes in frequency and etiology of acute renal failure in pregnancy (1980-1997). Ren Fail. 1998;20:513-7.
Altintepe L, Kazim G, Tonbul HZ. Etiology and prognosis in 36 AKI cases related to pregnancy in central Anatolia. Eur J Gen Med. 2005;2:110-3.
Ibrahim A, Ahmed MM, Kedir S, Bekele D. Clinical profile and outcome of patients with acute kidney injury requiring dialysis - An experience from a haemodialysis unit in a developing country. BMC Nephrology. 2016;17(1):1-5.
Godara SM, Kute VB, Trivedi HL, Vanikar A V., Shah PR, Gumber MR, et al. Clinical profile and outcome of acute kidney injury related to pregnancy in developing countries: a single-center study from India. Saudi J Kidney Dis Transpl. 2014;25(4):906-11
Bekele D, Ahmed M, Ibrahim A, Kedir S, Chan G. Profile and outcomes of women with pregnancy-related acute kidney injury requiring dialysis at a center in Ethiopia. Int J Gynecol Obstet. 2017;138(2):138-41.
Mahesh E, Puri S, Varma V, Madhyastha PR, Bande S, Gurudev KC. Pregnancy-related acute kidney injury: An analysis of 165 cases. Indian J Nephrol. 2017;27(2):113.
Bokhari SRA, Inayat F, Jabeen M, Sardar Z, Saeed S, Malik AM, et al. Characteristics and Outcome of Obstetric Acute Kidney Injury in Pakistan: A Single-center Prospective Observational Study. Cureus. 2018;10(9).
Patel M, Sachan R, Radheshyam, Sachan P. Acute renal failure in pregnancy: Tertiary centre experience from north Indian population. Niger Med J. 2013;54(3):191.
Pandey D, Redkar N. Acute renal failure in pregnancy at a tertiary level hospital in Mumbai: An epidemiological profile. Ann Int Med Dent Res. 2016.
Ali A, Ali MA, Ali MU, Mohammad S. Hospital outcomes of obstetrical-related acute renal failure in a tertiary care teaching hospital. Ren Fail. 2011;33(3):285-90.