Acute kidney injury and its outcome in obstetrics
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20202338Keywords:
Feto maternal outcome, Hemodialysis, Hypertension, Kidney injury, PregnancyAbstract
Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) 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 for management.
Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and 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 (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.
Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause).
References
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.
Nwoko R, Plecas D, Garovic VD. Acute kidney injury in the pregnant patient. Clin Nephrol. 2014;78:478-86.
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 Commit Pract Bullet Obstet 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.
Kumar KS, Krishna CR, Siva Kumar V. Pregnancy related acute renal failure. Obstet Gynecol India. 2006;56:308-10.
Najar MS, Shah AR, Wani IA, Reshi AR, Banday KA, Bhat HA, et al. Pregnancy related acute kidney injury: a single centre experience from the Kashmir valley. Indian J Nephrol. 2008;18:159-61.
Prakash J, Kumar H, Sinha DK, Kedalaya PG, Pandey LK, Srivastava PK, et al. Acute renal failure in pregnancy in a developing country: twenty years of experience. Renal Failure. 2006;28(4):309-13.
Patel BS, Patel FB, Bhatt MK. Acute renal failure in obstetrics. J Obstet Gynecol India. 2000;50(3):40.
Prakash J, Ganiger VC. Acute kidney injury in pregnancy-specific disorders. Indian J Nephrol. 2017:27(4):258.
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;26(4):262-7.
Liu 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.
Liu YM, Hong DB, Jiang ZZ, Huang YJ, Wang NS. Pregnancy-related acute kidney injury and a review of the literature in China. Internal Med. 2015;54(14):1695-703.
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.
Ganesan C, Maynard SE. Acute kidney injury in pregnancy: the thrombotic microangiopathies. J Nephrol. 2011;24(5):554-63.
