Outcome of Pregnancy-Related Acute Kidney Injury and Resulting Maternal Renal Morbidity in a South Asian Population: A Single-Center Study

Objective The study aimed to determine the outcome of pregnancy-related acute kidney injury (PR-AKI) and resulting maternal renal morbidity in a single center of a low-to-middle-income country (LMIC) in the South Asian region. The objective of the research was to calculate the percentage of patients requiring renal replacement therapy after suffering from PR-AKI, and the reversibility of the insult. A comparison of early versus late presentation after PR-AKI in terms of renal outcome was also made. Materials and methods This was a retrospective study conducted in the Nephrology Department of Pakistan Kidney and Liver Institute and Research Centre (PKLI & RC), Lahore, Pakistan. A total of 42 female patients aged 18-45 years presented to the outpatient or acute medical unit of PKLI & RC between April 2018 and April 2025 with PR-AKI. Their clinical course and outcomes were followed for twelve weeks and categorized as resolution versus development of chronic kidney disease (CKD) and/or end-stage renal disease (ESRD). Laboratory investigations, imaging, and renal biopsy findings were tabulated and analyzed using IBM SPSS 27 and Microsoft Excel (Microsoft® Corp., Redmond, WA, USA). Results Stage III AKI was most prevalent, seen in 81% (n=34), followed by Stage II AKI in 14.3% (n=6) and Stage I AKI in 4.8% (n=2). The most common cause of PR-AKI was postpartum hemorrhage (PPH), observed in 35.7% (n=15) of women, followed by sepsis in 23.8% (n=10). Other causes included pre-eclampsia, thrombotic microangiopathy (TMA), eclampsia, non-steroidal anti-inflammatory drug (NSAID) abuse, and dehydration. Early presentation after delivery was associated with better outcomes in terms of maternal renal morbidity and progression to ESRD. Patients who progressed to ESRD presented at an average of 43.5 ± 20.6 days after delivery, whereas those who did not progress presented earlier, at an average of 27.9 ± 29.6 days. This difference in presentation days according to ESRD status was statistically significant (p = 0.009). No statistically significant correlation was found between pregnancy-induced hypertension (PIH), eclampsia, or pre-eclampsia and progression to CKD and/or ESRD (p > 0.05). In terms of maternal renal outcome, CKD was diagnosed in 66.6% (n=28), of which 42.8% (n=18) became dialysis dependent. Complete resolution of PR-AKI was observed in 28.5% (n=12). Maternal mortality was observed in 16.2% (n=6), with 9.5% (n=4) being dialysis dependent at the time of death. Causes of maternal mortality ranged from septic shock to multi-organ failure in the background of acute kidney injury. Fetal mortality was observed in 30.6% (n=11), including both intrauterine and neonatal deaths. Pre-eclampsia was found to be significantly associated with fetal mortality (p = 0.023), with the odds of fetal mortality due to pre-eclampsia being 13.71 (1.31-143.44) times higher than in non-pre-eclampsia patients. Conclusion Early presentation and timely intervention are crucial for preserving maternal renal function after PR-AKI. Best practices should be implemented, especially in poverty-stricken areas, to avoid complications such as PPH and sepsis that may lead to AKI in pregnant or peri-partum women. It is imperative to strengthen antenatal screening, skilled birth attendance, and early referral systems to minimize the burden of avoidable complications.