Spectrum of acute kidney injury in obstetrics

Authors

  • Amandeep Kaur Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • Seema Chopra Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • Vanita Suri Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • Harbir Singh Kohli Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20184122

Keywords:

Acute kidney injury, Renal replacement therapy, Sepsis

Abstract

Background: Acute kidney injury (AKI) associated with pregnancy is a serious medical complication which can lead to significant maternal as well as perinatal morbidity and mortality.

Methods: Forty antenatal/postnatal /postabortal patients who fulfilled the Acute kidney injury network criteria were enrolled and followed up till 3 months of acute insult/ postpartum.

Results: Majority of the patients, 23/40(57.5%) with AKI presented in postpartum period, 14/40(35%) developed AKI in antenatal period and 3/40(7.5%) were postabortal. AKI was attributable mostly to sepsis in 11/40(27.5%) followed by hypertension and its complications which included eclampsia in 5/40(12.5%) and HELLP syndrome in 3/40(7.5%). 5/40(12.5%) patients had postpartum haemorrhage and abruptio placentae was found in 2/40(5%). Renal replacement therapy (RRT) was the treatment in majority of them 28(70%). 25/40(62.5%) had complete recovery of their renal functions whereas maternal mortality was seen in 10/40(25%) patients. Prolonged anuria was found to be highly significant in our study and served as poor prognostic factor towards maternal outcome (p=0.034). Out of 37 patients, 21(56.7%) had live births and 16 patients (43.2%) had still births.

Conclusions: Timely initiation of RRT in patients with AKI associated with pregnancy has a good maternal outcome in the form of complete recovery of renal functions.

References

Goplani KR, Shah PR, Gera DN, Gumber M, Dabhi M, Feroz A et al. Pregnancy related acute renal failure: a single centre experience. Indian J Nephrol. 2008;18(1):17-21.

Kumar S, Ramakrishna C, Sivakumar V. Pregnancy related acute renal failure. J Obstet Gynecol India. 2006;56:308-10.

Chugh KS, Singhal PC, Sharma BK, Pal Y, Mathew MT, Dhall K, et al. Acute renal failure of obstetric origin. Obstet Gynecol 1976;48(6):642-46.

Prakash J, Singh RG, Tripathi K et al. Acute renal failure in pregnancy. J Obstet Gynaecol India 1985;35:233-38.

Chugh KS, Sakhuja V, Malhotra HS, Pereira BJ.. Changing trends in acute renal failure in third world countries-Chandigarh study. Q J Med 1989;73(3):1117-23.

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG et al. Acute Kidney Injury Network. Crit Care 2007;11(2):R31.

Jefferson A, Thurman JM, Schrier RW. Pathophysiology and Etiology of Acute Kidney Injury. In: Jurgen F, Johnson RJ, Feehally J. Comprehensive clinical nephrology. 4th ed. New York: Elsevier; 2010.

Conrad KP, Lindheimer M. Renal and cardiovascular alterations. In: Lindheimer M, Roberts J, Cunningham F, eds. Chesley’s hypertensive disorders in pregnancy. 3rd ed. Amsterdam: Elsevier; 2009:297-334.

Jeyabalan A, Conrad KP. Renal function during normal pregnancy and preeclampsia. Front Biosci 2007;12(1):2425-37.

Rohina SA, Vineet VM, Anil FJ, Manoj G. Acute renal failure in pregnancy: Our experience. Saudi J Kidney Dis Transpl 2014;25(2):450-55.

Suraj MG, Vivek BK, Hargovind LT, Aruna VV, Pankaj RS, Manoj RG et al. Clinical profile and outcome of Acute kidney injury related to pregnancy in developing countries: A single centre study fromIndia. Saudi J Kidney Dis Transpl 2014; 25(4):906-11.

Kilari SK, Chinta RK, Vishnubhotla SK. Pregnancy related acute renal failure. J Obstet Gynecol India 2006; 56(4):308-10.

Najar MS, Shah AR, Wani IA, Reshi AR, Banday KA, Bhat MA et al. Pregnancy related acute kidney injury: A single centre experience from the Kashmir Valley. Indian Journal of Nephrology 2008;18(4):159-61.

Smith K, Browne JC, Shackman R, Wrong OM. Acute Renal Failure of Obstetric Origin: An Analysis of 70 Patients. Lancet 1965;2(7408):351-54.

Kennedy AC, Burton JA, Luke RG, Briggs JD, Lindsay RM, Allison ME et al. Factors affecting the prognosis in acute renal failure: A survey of 251 cases. Q J Med 1973;42(165):73-86.

Ali A, Zaffar S, Mehmood A, Nisar A. Obstetrical acute renal failure from Frontier Province : A 3 years prospective study. J Postgrad Med Inst 2004;18(1):109-17.

Rassmussen PE, Nielson FR. Hydronephrosis during pregnancy: A literature survey. Eur J Obstet Gynecol Reprod Biol 1988;27(3):249.

Conrad KP, Gandley RE, Ogawa T. Endothelin mediates renal vasodilitation and hyperfiltration during pregnancy in chronically instrumented conscious rats. Am J Physiol 1999;276(5):767.

Sibai BM, Ramadan MK. Acute renal failure in pregnancy complicated by hemolysis, elevated liver enzymes, and low platelets. Am J Obstet Gynecol 1993;168(6):1682-90.

Silva GB, Monteiro FA, Mota RM, Paiva JG, Correia JW, Bezerra Filho JG et al. Acute kidney injury requiring dialysis in obstetric patients. Arch Gynecol Obstet 2009; 279(2):131-7.

Pahwa N, Bharani R, Kumar R. Post-Partum Acute Kidney Injury. Saudi J Kidney Dis Transpl 2014;25(6):1244-47

Beaufils M. Pregnancy. In: Davison A, Cameron J, Grunfeld, Ponticelli C, Ritz E, Winearls C, Ypersele C. Oxford text book of clinical nephrology.3rd ed. Great Clarendon Street: Oxford university press; 2005:1604-12.

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Published

2018-09-26

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Original Research Articles