Acute Kidney Injury in Pregnancy – A Prospective Observational Study

Background: Pregnancy-related acute kidney injury (PR-AKI) is an important entity and is responsible for 15-20% of AKI in developing countries.It is a serious obstetric complication with significant risk to maternal and fetal health.In India, the maternal mortality due to pregnancy related AKI is 5.8%.In developed countries like the USA, there is a renewed increase in the incidence of pregnancy-related AKI from 0.04 to 0.12%.Thus, robust epidemiological studies are needed to determine the prevalence, risk factors and regional variations of AKI during pregnancy.In our study, we studied the etiology, presentation, and fetal and maternal outcomes of PRAKI in a tertiary care center.Materials and methods: This was a prospective observational study that was conducted on patients admitted to Vani Vilas Hospital and Bowring and lady Curzon Hospital, Bengaluru medical college and research institute (BMCRI), Bengaluru, from November 2014 to May 2016.About 60 patients were included during the study period, and kidney disease improving outcomes (KDIGO) criteria were applied for the diagnosis of PRAKI.The data was collected using a predesigned proforma.Urine output and serum creatinine levels were monitored.The renal biopsy was done in selected cases.The details of therapeutic measures and hospital stay along with the maternal and perinatal outcomes are recorded and discussed.Results: In our study, the mean age was 23.9 years.Acute kidney injury was found to be more common in primigravida (53.3%) with the majority of them occurring in the third trimester (41.6%), followed by puerperal period (30%).Hypertensive disorders of pregnancy (60%) and obstetrical hemorrhage (46.6%) were the two main causes for PRAKI and sepsis was a contributing factor in 28.3% of the cases.Maternal outcome was favorable, 73.3% had complete renal recovery, 8.3% attained partial recovery, but none progressed to irreversible renal failure.Around 65% of the patients were managed conservatively, and 16.6% required dialysis.Cases of 31 (51.7%)required an intensive care unit (ICU).The maternal mortality was 11 (18.3%).About 51.6% had preterm births, and 14 (27.45%)intrauterine fetal deaths.Neonatal intensive care unit (NICU) admission accounted for 41.7% of births.Conclusion: Pregnancy-related acute kidney injury is a preventable condition.According to our study, hypertensive disorders of pregnancy and obstetrical hemorrhage were the major cause for PRAKI, with early detection and timely management, the complication of AKI can be mitigated.As the peak incidence of AKI was between 21 -25 years in our study, educating this age-group regarding the importance of regular antenatal care, identification of high risk factors and prompt intervention plays a vital role.