Prognostic significance of liver affliction in pregnancy related acute kidney injury in an Egyptian cohort

Pregnancy related-acute kidney injury (Pr-AKI) is a major public health problem that poses serious maternal and fetal risks, particularly in low-resource settings. Liver affection including conditions unique to pregnancy such as Hyperemesis gravidarum, preeclampsia/HELLP syndrome, acute fatty liver of pregnancy or pre-existing liver conditions, can further compromise these adverse outcomes. Given the critical yet understudied nature of liver involvement in Pr-AKI, this research aimed to explore the pattern of liver affliction in women with Pr-AKI and its impact on maternal and fetal outcomes. This 5-year retrospective study included women with severe Pr-AKI (stage III) according to the KDIGO definition. The medical records of the included patients were reviewed for evidence of gestational liver disorders such as (HELLP syndrome, acute fatty liver of pregnancy (AFLP), intrahepatic cholestasis of pregnancy), or evidence of preexisting/coincidental liver disease. The patients' clinical/laboratory data and outcomes were collected and analyzed. This study of 77 pregnant women with severe Pr-AKI found a high maternal mortality rate of 18.2% and fetal mortality of 39%. 35.5% of survivors in the liver affliction group developed chronic kidney disease requiring hemodialysis. Most women presented in the third trimester with preeclampsia/HELLP syndrome, other conditions included, acute fatty liver of pregnancy and preexisting liver cirrhosis. Women with liver affection presented at older gestational ages, had higher maternal mortality, more severe hematological abnormalities and worse fetal and renal outcomes. Severe liver dysfunction was the only significant predictor of maternal mortality, which was primarily observed in patients with shock liver or pre-existing decompensated liver cirrhosis. Liver affliction is not an uncommon problem among women with Pr-AKI and it is associated with higher maternal mortality and poor fetal and renal outcomes. Further research is needed to better understand the various liver diseases that arise in pregnancy and their impact on outcomes in Pr-AKI patients.