Acute kidney injury in obstetrics: a five-year study in a tertiary centre

Authors

  • Sushma H. Papegowda Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences and Research, Imphal, Manipur, India
  • Pratima K. Devi Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences and Research, Imphal, Manipur, India
  • Ranjit L. Singh Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences and Research, Imphal, Manipur, India
  • Agalya Muruganadam Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences and Research, Imphal, Manipur, India
  • Zikpuii L. Tochhawng Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences and Research, Imphal, Manipur, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20196007

Keywords:

Foetal outcome, Maternal outcome, Pregnancy related acute kidney injury, RIFLE criteria

Abstract

Background: Pregnancy Related Acute Kidney Injury (PRAKI) is a major cause of maternal and foetal morbidity and mortality in developing countries. The incidence has declined due to improvements in reproductive health but it is still associated with significant perinatal mortality and maternal morbidity. It may be due to decrease in renal perfusion or ischemic tubular necrosis from a variety of conditions encountered during pregnancy. Our study aims at determining the predisposing factors and causes of AKI during pregnancy and its impact on maternal and foetal outcome.

Methods: A retrospective cohort study over a period of 5 years was conducted on pregnant women with AKI as per inclusion and exclusion criteria. The detailed history, events, mode of delivery, cause leading to AKI, management, hospital stay, maternal and foetal outcome were studied in detail and evaluated. These patients were classified according to RIFLE criteria and were followed up for hospital stay and residual morbidities.

Results: The incidence of PRAKI in the study was 0.07% (36 out of 50,735 deliveries) and among obstetric ICU patients, it was 6.8%. Most of the majority of the cases were unbooked (66.7%) and multipara (61.1%). Maternal morbidity was seen in 66.7% and mortality was 27.8%. Poor foetal outcome was seen in 44.4%.

Conclusions: Haemorrhage is the most common cause of PRAKI, followed by toxaemia of pregnancy and sepsis. Early detection and meticulous management of haemorrhage, hypertension and sepsis reduce the incidence of PRAKI and associated maternal mortality.

References

Mahesh E, Puri S, Varma V, Madhyastha PR, Bande S, Gurudev KC. Pregnancy related acute kidney injury: An analysis of 165 cases. Indian J Nephrol 2017;27(2):113-7.

Arora N, Mahajan K, Jana N, Taraphder A. Pregnancy related acute renal failure in eastern India. Int J Gynecol Obstet. 2010;111(3):213-6.

Kidney Disease Improving Global Outcomes. KDIGO Guidelines on AKI, 2014. Available at: https://kdigo.org/wp-content/uploads/2017/04/KD IGO-AKI-Guideline_Cass-2014.pdf. Accessed on 24th February 2019.

Eshwarappa M, Madhyastha PR, Puri S, Varma V, Bhandari A, Gurudev C. Postpartum acute kidney injury: a review of 99 cases. Renal Failure 2016;38(6):889-93.

Munib S, Khan SJ. Outcome of pregnancy related acute renal failure. RMJ. 2008;33(2):189-92.

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

Dambal A, Lakshmi KS, Gorikhan G, Umadi MM, Kalsad ST, Madhavaranga MP, et al. Obstetric acute kidney injury; a three-year experience at a medical college hospital in North Karnataka, India. J Clin Diagn Res. 2015;9(3):1-14.

Turney JH, Ellis CM, Parsons FM. Obstetric acute renal failure 1956-1987. Br J Obstet Gynaecol. 1989;96(6):679-87.

Mir MM, Nair MS, Chaudary AM, Azad H, Reshi AR, Banday KA et al. Postpartum acute kidney injury: experience of a tertiary care centre. Indian J Nehrol. 2017;27:181-4.

Siribamrungwong M, Chinudomwong P. Relation between acute kidney injury and pregnancy-related factors. J Acute Dis. 2016;5(1):22-8.

Cunningham FG, Williams JW. Williams obstetrics (24th ed.). Renal and Urinary Tract Disorders. Norwalk, McGraw-Hill; 2014:1063-1064.

Aggarwal RS, Mishra VV, Jasani Af, Gumber M. Acute renal failure in pregnancy. Saudi J Kidney Dis Transpl. 2014;25(2):450-5.

Baskett TF, O’Conell CM. Maternal critical care in obstetrics. J Obstet Gynaecol Can. 2009;31:218-21.

Stewart GK, Goldstein PJ. Theurapeutic abortion in California. Effects of septic abortion and maternal mortality. Obstet Gynaecol. 1971;37:510-4.

Ford JB, Roberts CL, Simpson JM, Vaughan J, Cameron CA. Increased postpartum hemorrhage rates in Australia. Int J Gynecol Obstet. 2007;98:237-43.

Prakash J. The kidney in pregnancy: a journey of three decades. Indian J Nehrol. 2012;22:159-67.

Lopes JA, Jorge S. The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review. Clin Kid J. 2013;6:8-14.

Khanal N, Ahmed E, Akhtar F. Epidemiology, causes and outcome of obstetric acute kidney injury. Novel insights on chronic kidney disease, acute kidney injury and polycystic kidney disease. Rijeka, InTech. 2012:67-81.

Lindheimer MD, Grunfeld JP, Davison JM. Renal Disorders. In: Barron WM, Lindheimer MD, Davison JM (eds). Medical Disorders during Pregnancy (2nd ed.) Mosby: St. Louis; 1995:37-62.

Downloads

Published

2019-12-26

Issue

Section

Original Research Articles