Acute kidney injury in pregnancy—a single center experience. (21st October 2015)

• Record Type: Journal Article
• Authors: Gopalakrishnan, Natarajan; Dhanapriya, Jeyachandran; Muthukumar, Periyasamy; Sakthirajan, Ramanathan; Dineshkumar, Thanigachalam; Thirumurugan, S.; Balasubramaniyan, T.
• Is Part Of: Renal failure. Volume 37:Number 9(2015)
• Page Start: 1476
• Page End: 1480
• Publication Date: 2015-10-21
• Subjects: Acute kidney injury -- chronic kidney disease -- cortical necrosis -- dialysis -- pregnancy; Chronic renal failure -- Periodicals; Acute renal failure -- Periodicals; Uremia -- Periodicals; 616.614005
• DOI: 10.3109/0886022X.2015.1074493
• Languages: English
• ISSNs: 0886-022X

Abstract

Abstract: Background : Acute kidney injury (AKI) is a serious complication in pregnancy, resulting in significant maternal morbidity/mortality and fetal loss. Although the incidence of pregnancy-related acute kidney injury (PRAKI) has decreased in developed countries, it is still common in developing nations. Methods : A prospective observational study was done between January 2010 and December 2014 to report the incidence, clinical spectrum, maternal and fetal outcome of AKI in pregnancy. Results : Total number of patients: 130; mean age: 25.4 ± 4.73 years. The incidence of AKI in pregnancy was 7.8%. Most of the AKI was noted in postpartum period (68%). Etiology of AKI was sepsis (39%), pre-eclampsia (21%), placental abruption (10%), acute diarrheal disease complicating pregnancy (10%), thrombotic microangiopathy (TMA) (9%), postpartum hemorrhage (2%) and glomerular diseases (9%). Renal biopsy ( n = 46) done in these patients showed renal cortical necrosis (16), TMA (11), acute tubular injury (9), acute tubulointerstitial disease (1) and glomerular disease (9). Live births occurred in 42% of patients with vaginal delivery in 34% cases. Thirty-four patients were managed conservatively, while 96 required dialysis. Complete recovery occurred in 56% and about 36% had persistent renal failure at 3 months. Mortality rate observed was 8%. In univariate analysis, low mean platelet count, higher peak serum creatinine, dialysis dependency at presentation and histopathologically presence of cortical necrosis and TMA predicted the progression to chronic kidney disease. Conclusion : AKI in pregnancy was common in postpartum period and sepsis being the commonest cause.