EP17.70: Outcome of acute kidney injury secondary to hypertensive complications of pregnancy

Obstetric acute renal failure, or pregnancy related acute kidney injury(PR-AKI), is a potentially life threatening complication. Incidence varies from 1-2.8% in developed countries to 4.2-15% in developing countries. Abruptio placenta, eclamptic toxemia, postpartum hemorrhage (PPH) and puerperal sepsis are the commonest pregnancy-related situations responsible for AKI which may progress to chronic kidney disease(CKD). Our aim was to study outcome of AKI related to pre-eclampsia, eclampsia and HELLP syndrome. Prospective observational study conducted in Labour ward and Dialysis unit of PGIMER, Chandigarh. We included 30 patients with AKI due to severe pre-eclampsia, eclampsia, HELLP syndrome and postpartum eclampsia. Renal parameters were followed up till 16 weeks after the acute event. Women with antecedent renal disease and other obstetric causes of AKI were excluded. 14(46.67%) were antenatal and 16(53.33%) postpartum. Toxemic abruption occurred in 40%, pre-eclampsia-eclampsia in 56.7% and HELLP in 46.7%) [*overlapping complications so total > 100%]. 24 (80%) presented with oliguria/anuria. Serum creatinine values were in range 1-3.99mg/dl in 12, 4-8 mg/dl in10 and > 8 mg/dl in eight patients. Severity of AKI according to KDIGO Stage was category I/II/III in 2/9/19 patients respectively. 53.33% required renal replacement therapy(RRT). Maximum Mean serum creatinine was 7.043mg% in those who progressed to CKD/ expired compared to 4.462 mg/dl in those who recovered. At 16 weeks follow up, 18 (60%) had complete recovery, 7 progressed to chronic kidney disease. There were 12 (40%) live births and 18 (60%) still births. We had 5 maternal mortalities. AKI progression to CKD was significantly associated with serum creatinine value at diagnosis of AKI (p= 0.001) and maximum serum creatinine (p = 0.006), increased number of RRT cycles (p = 0.001), and suboptimal antenatal care(p = 0.04). We expect a good prognosis with adequate antenatal care and early institution of RRT.