A study of pregnancy related acute kidney injury and its outcome at a tertiary care centre, civil hospital, Ahmadabad, Gujarat, India

Authors

  • Komal K. Agrawal Department of Obstetrics and Gynecology, B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
  • Mahima Jain Department of Obstetrics and Gynecology, B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20194385

Keywords:

Abortion, Feto maternal outcome, Hypertension, Kidney injury, Pregnancy, Recovery

Abstract

Background: Pregnancy related acute kidney injury (PRAKI) is acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of PRAKI is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity of diagnosis and management. A multi discipilinary team is often needed to optimize all aspects of the pregnant women’s care.

Methods: To study association and contributing factors in pregnancy related Acute Kidney injury, a retrospective study of 39 cases of acute kidney injury complicating pregnancies was carried out in department of obstetrics and gynaecology, B. J. Medical college over a period of 6 months, and results were studied and analysed. Etiological-factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and results were tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.

Results: The incidence of ARF in pregnancy was found to be 0.3%. Hypertension and its related complications were the most common causative factor. 59.5% of cases required hemodialysis and except for 6 cases (14.3%) all had complete or at least partial recovery from failure.

Conclusions: AKI complicating pregnancies are not uncommon in tertiary care centres. If recognized and treated promptly, recovery is assured in majority of 85.7% of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of ARF cases.

References

Nwoko R, Plecas D, Garovic VD. Acute kidney injury in the pregnant patient. Clin Nephrol. 2014;78:478-86.

Filipowicz E, Staszków M. Pregnancy-related acute kidney injury. Wiad Lek. 2016;69(5):721-4.

Prakash J, Prakash J, Niwas SS, Parekh A, Pandey LK, Sharatchandra L, et al. Acute kidney injury in late pregnancy in developing countries. Renal failure. 2010;32(3):309-13.

Goplani KR, Shah PR, Gera DN, Gumber M, Dabhi, M, Feroz A, et al. Pregnancy related acute renal failure: a single-center experience. Indian J Nephrol. 2016;18:17-21.

ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2018. ACOG Committee on Practice Bulletins- Obstetrics, Obstet Gynecol. 2002;99(1):159.

Huang C, Chen S. Acute kidney injury during pregnancy and puerperium: a retrospective study in a single center. BMC Nephrol. 2017;18(1):146.

Mahajan S, Tiwari S, Bhowmik D, Agarwal SK, Tiwari SC, Dash SC. Factors affecting the outcome of acute renal failure among the elderly population in India: a hospital based study. Int Urol Nephrol. 2006;38(2):391-6.

Prakash J, Ganiger VC. Acute kidney injury in pregnancy-specific disorders. Indian J Nephrol. 2017:27(4):258.

Najar MS, Shah AR, Wani IA, Reshi AR, Banday KA, Bhat MA, et al. Pregnancy related acute kidney injury: a single center experience from the Kashmir Valley. Indian J Nephrol. 2008;18(4):159.

Prakash J, Pant P, Prakash S, Sivasankar M, Vohra R, Doley PK, et al. Changing picture of acute kidney injury in pregnancy: Study of 259 cases over a period of 33 years. Ind J Nephrol. 2016 Jul;26(4):262-7.

Liu Y, Y, Bao H, Jiang Z, Huang Y, Wang N. Pregnancy-related Acute Kidney Injury and a Review of the Literature in China. Intern Med. 2015;54(14):1695-703.

Huang Y, Wang N. Pregnancy related acute kidney injury and a review of literature in china. 2016;23(4):502.

Huang C. Study of pregnancy related acute kidney injury at china in 2017. Available at: https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-017-0551-4.

Rao S. Acute kidney injury in pregnancy: the changing landscape for the 21st century. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932309/.

Arrayhani M, El Youbi R, Sqalli T. Pregnancy-related acute kidney injury: experience of the nephrology unit at the university hospital of fez, morocco. ISRN Nephrol. 2012;2013.

Godara SM, Kute VB, Goplani KR, Gumber MR, Gera DN, Shah PR, et al. Mucormycosis in renal transplant recipients: predictors and outcome. Saudi J Kid Dis Transplant. 2011;22(4):751.

Godara SM, Kute VB, Trivedi HL, Vanikar AV, 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 Kid Dis Transplant. 2014;25(4):906.

Downloads

Published

2019-09-26

Issue

Section

Original Research Articles