Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 16 , ISSUE 5 ( September-October, 2024 ) > List of Articles

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Pregnancy-related Acute Kidney Injury: Our Experience in a Tertiary Care Center

Mahalakshmi Mahalingam, Meena T Sundarraj, Geetha Mohan, Sangeetha Ramesh, Sharmiladevi Kothandaraman

Keywords : Acute kidney injury, Hypertensive disorders of pregnancy, Maternal mortality, Maternal sepsis, Preeclampsia, Pregnancy-related acute kidney injury

Citation Information : Mahalingam M, Sundarraj MT, Mohan G, Ramesh S, Kothandaraman S. Pregnancy-related Acute Kidney Injury: Our Experience in a Tertiary Care Center. J South Asian Feder Obs Gynae 2024; 16 (5):583-587.

DOI: 10.5005/jp-journals-10006-2505

License: CC BY-NC 4.0

Published Online: 23-10-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Pregnancy-related acute kidney injury (PRAKI) has been identified as an autonomous risk factor for maternal death. The key to solving this problem is the early identification, and diagnosis of PRAKI and management of the underlying factors responsible. Pregnancy-related acute kidney injury does not stop with affecting the current pregnancy; it has lasting impacts in terms of chronic kidney disease. Hence, it is crucial to investigate factors leading to PRAKI in order to understand its impact on both maternal and fetal outcomes and improve the management strategies. The primary objective of this study is to comprehensively analyze the variables contributing to PRAKI in terms of maternal age, parity, mode of delivery, time of diagnosis and etiology. A secondary objective is to study the maternal and fetal outcomes and the variables impacting maternal mortality in cases of PRAKI. Methods: A retrospective observational study was conducted for a period of 1 year, from January to December 2019. All women with a diagnosis of PRAKI according to KDIGO criteria, admitted to institute of obstetrics and gynecology, Chennai, irrespective of gestational age, delivery status and recovery status, were included in the study. Of the 16,469 deliveries in the year 2019 at the Institute of Obstetrics and Gynecology, 19 qualified the PRAKI diagnostic criteria according to KDIGO. Data regarding the demographic data, clinical presentation, etiology of acute kidney injury (AKI), laboratory investigations including blood biochemistry and hemogram, dialysis dependency, transfusion dependency, maternal outcome and fetal outcome were collected from the hospital database. The data were tabulated using MS Excel. SPSS v23 was used for statistical analysis. Results: In our hospital, the incidence of PRAKI per 10,000 admissions for delivery is 11.5; Mean age in our study was 25.26 ± 3.59, and 63.2% of affected population belonged to the 20–25-year age-group, in par with the recent literature. Prim gravida was most frequently affected. All the 19 cases diagnosed as PRAKI in our study was diagnosed exclusively in the postpartum period, with 12 cases (63.2%) occurring within 48 hours of postpartum indicating the better management of early trimester complications and rise in the hypertensive disorders of pregnancy. Severe preeclampsia (52.6%) and sepsis (31.6%) were identified as the most frequent underlying conditions resulting in PRAKI. We report a higher rate of maternal mortality compared with other literature. Hemolysis, elevated liver enzymes, and low platelet levels (HELLP) and Abruption, which are severe complications of hypertensive disorders of the pregnancy were reported in higher proportions in our study, contributing to the maternal mortality being reported as high as 57.9%. the fetal loss was also elevated at 43.75%. Conclusion: The global incidence of PRAKI has increased, especially in developing countries. In our observation, majority of PRAKI occurred in primigravida and in the postpartum period, consistent with recent trends. The maternal mortality rates related to PRAKI were alarmingly high, especially in association with hypertensive disorders and sepsis. The presence of severe preeclampsia and sepsis prominently influenced outcomes in our study. Acute kidney injury being a significant contributor to maternal as well as fetal mortality and morbidity, its prompt identification and management are imperative.


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