Clinical Study on the Risk Factors and Pregnancy Outcomes of Pregnancy-Related AKI and Pregnancy Complicated with CKD

Background: Pregnancy-related kidney diseases globally threaten maternal and infant health, emerging as key research areas in obstetrics, gynecology, and nephrology. This study aims to compare pregnancy-related acute kidney injury (Pr-AKI) and pregnancy complicated with chronic kidney disease groups, identify risk factors for renal function deterioration and adverse pregnancy outcomes, and guide clinical prevention to reduce poor maternal and infant outcomes. Methods: Patients admitted to the First Affiliated Hospital of Kunming Medical University from 2016-2023 were enrolled. They were categorized into Pr-AKI (60 cases: 20 each in mild, moderate, and severe injury subgroups), Pr-CKD (40 cases: 20 in stage1-2 and 20 in stage3-5), and a control group of healthy late-pregnancy women. Clinical data were analyzed using univariate, ordinal logistic, multiple logistic, and multiple linear regression methods. Results: 1.Pr-AKI group: Severe and moderate injury subgroups had higher blood pressures, abnormal creatinine, urea, and uric acid levels, and increased proportions of small-for-gestational-age infants and severe preeclampsia compared to the mild subgroup. Uric acid, albumin, and other factors significantly influenced renal injury severity. 2.Pr-CKD group: Diastolic blood pressure and triglyceride levels differed significantly among groups. Stage3-5 patients had higher incidences of preterm birth, low birth weight, and small-for-gestational-age infants. Conclusion: This study elucidates the relationship between pregnancy-related renal injury risk factors and pregnancy outcomes. Blood pressure control is crucial for preventing renal damage during pregnancy, interacting with other metabolic abnormalities. In Pr-CKD, age, blood pressure, and metabolic factors contribute to renal impairment. We propose a hierarchical management model, but prospective studies are required to confirm the link between abnormal blood lipids and pregnancy outcomes for better pregnancy care. Funding: Other NIH Support - This work was supported by Yunnan Major Scientific and Technological Project, (grant no. 202102AA100060), Yunnan Province's Xingdian. Talents Program for Renowned Physicians Support Plan., Government Support – Non-U.S.