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  • Title: Acute Kidney Injury Due to Obstetric Complications.
    Author: Mal P, Ahsan MN, Kumar M, Gurbukshani S, Fatima A, Khanzada I.
    Journal: J Coll Physicians Surg Pak; 2023 May; 33(5):535-538. PubMed ID: 37190688.
    Abstract:
    OBJECTIVE: To evaluate the factors, causes, and outcomes of acute kidney injury (AKI) among pregnant females admitted to a tertiary care hospital. STUDY DESIGN: An observational study. Place and Duration of the Study: Department of Nephrology, Liaquat University Hospital, Hyderabad, from April to October 2022. METHODOLOGY: Patients with AKI due to obstetric complications were enrolled and followed for three months. AKI was defined as a rise in serum creatinine of 0.3 mg/dl within 48 hours, an increase in serum creatinine of 1.5 times baseline value within the previous 7 days, or a decrease in urine output of 0.5 ml/kg/hr for 6 hours. Good antenatal care was defined as at least one visit to a healthcare provider during pregnancy. Patients with the history of diabetes or hypertension, chronic kidney disease or history of renal stones were excluded from the study. Favourable outcomes such as complete recovery were assessed at the time of discharge in terms of renal function testing. Patients who had normal renal function, adequate urine output, and became dialysis independent were labelled as completely recovered. Unfavourable outcomes were assessed in terms of progress towards either chronic kidney disease or death. RESULTS: Of the initially enrolled 66 patients, 6 were lost to follow-up and 60 patients were included in the final analysis. The mean age was 28.67±5.41 years. Only 2 patients had received good antenatal care (3.3%). Puerperal sepsis was the primary aaetiology of AKI in 20 patients (33.3%), antepartum haemorrhage in 14 patients (23.3%), and postpartum haemorrhage in 16 (26.7%) patients. In eight cases, there was combined haemorrhage and sepsis. Other causes of AKI were pre-eclampsia and placentae abruption. Nine of 60 patients were treated conservatively, while 51(85%) were treated with dialysis. Five patients died (8.3%), fifteen recovered (25%), and 40(66.7%) patients who needed dialysis at the time of discharge acquired chronic renal disease throughout the three-month follow-up period. CONCLUSION: An overwhelming majority of obstetric-related AKI patients had a suboptimal antenatal care history. The most frequent aetiology was puerperal sepsis, followed by haemorrhage. Majority of the patients with required hemodialysis and most of them did not recover in three months resulting in dialysis-dependent chronic kidney disease. KEY WORDS: Acute kidney injury, Obstetric acute kidney injury, Pregnancy, Obstetric complications, Antenatal care, Haemorrhage, Puerperal sepsis.
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