Renal Challenges in Pregnancy: Clinical Spectrum and Outcomes of Acute Kidney Injury in a Tertiary Care Center

Background Pregnancy-related acute kidney injury (PR-AKI) remains a major contributor to maternal and perinatal morbidity and mortality, particularly in low- and middle-income countries such as India. While the incidence of PR-AKI has declined globally, preventable causes such as preeclampsia, sepsis, and hemorrhage continue to predominate in resource-limited settings. This study aimed to evaluate the clinical profile, etiological spectrum, maternal and perinatal outcomes, and predictors of adverse prognosis among women with PR-AKI. Methods A prospective observational study was conducted at a tertiary care teaching hospital in India, including 120 women diagnosed with PR-AKI over a one-year period. Baseline demographics, antenatal care utilization, etiologies, laboratory parameters, and management interventions (including dialysis and ICU admission) were recorded. Maternal outcomes (mortality, dialysis dependence, and recovery) and perinatal outcomes (gestational age at delivery, low birth weight, neonatal intensive care unit (NICU) admission, and perinatal mortality) were analyzed. Statistical comparisons were made using chi-square and t-tests, with logistic regression applied to identify independent predictors of adverse outcomes. Results The mean maternal age was 26.9 ± 4.8 years, with 61.7% residing in rural areas and 45% lacking formal antenatal care (ANC) registration. The leading etiologies were preeclampsia/eclampsia (36.7%), sepsis (28.3%), and hemorrhage (19.2%). Dialysis was required in 42 (35%) women, and 18 (15%) required ICU admission. Maternal mortality was 14.2%, while 11% remained dialysis-dependent at discharge. Perinatal outcomes were poor: mean gestational age was 35.4 ± 3.8 weeks, 56.3% of neonates were low birth weight, 34% required NICU admission, and perinatal mortality reached 32.1%. Independent predictors of adverse maternal outcomes included delayed hospital presentation (>48 hours), KDIGO (kidney disease: improving global outcomes) stage 3, dialysis requirement, and ICU admission, while adverse perinatal outcomes were associated with unregistered ANC status, severe renal dysfunction (creatinine > 5 mg/dL), thrombocytopenia, and preterm delivery. Conclusion PR-AKI continues to exert a substantial burden in India, with high maternal and perinatal morbidity and mortality. Timely recognition, adequate antenatal care coverage, and early referral remain crucial in improving outcomes. Preventive strategies targeting sepsis, hypertensive disorders, and hemorrhage, alongside strengthening dialysis and critical care access, are essential for reducing the dual burden of maternal and perinatal loss.