Management and outcome assessment of pregnancy-related acute kidney injury in Western India: a single centred, prospective, observational study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20212232Keywords:
Pregnancy-related acute kidney injury, Maternal mortality, Foetal mortality, HaemodialysisAbstract
Background: Pregnancy-related acute kidney injury (PRAKI) remains a large public health problem, with decreasing incidences in developing countries like India. However, some single centred studies from United States and Canada revealed an increasing incidence of PRAKI. This increase could be due to higher rates of hypertensive disorders of pregnancy.
Methods: To assess the management and outcome of PRAKI. In this prospective, observational study, total 1021 cases of acute renal failure were observed.
Results: 96 (9.4%) were of obstetric origin and enrolled as per inclusion criteria. Regarding management of PRAKI, 78 out of 96 (81.25%) required haemodialysis. 67 (69.79%) among them were managed with intermittent haemodialysis (IHD) while 10 (10.41%) who had hypotension at presentation were dialysed with slow, low efficiency dialysis (SLED). Continuous renal replacement therapy (CRRT) was done in 1 (10.4%) patient. Maternal mortality in this PRAKI study was 19 of 96 patients (19.79%). Sepsis accounted for 52.63% of deaths. Foetal death was observed in 58 out of 96 patients (60.41%) comprising of intrauterine death in 55 (55.29%) and abortion in 3 (3.13%) patients. 38 of 96 (39.58%) patients gave birth to live born child out of which 27 were at full term and 11 were preterm.
Conclusions: In order to avoid further increase in PRAKI in India, treating obstetrician should remain aware of management and outcome of PRAKI. The better awareness of diagnosis and management protocols will ultimately lead to further reduction in prevalence of PRAKI in our country.
References
Stratta P, Besso L, Canavese C, Grill A, Todros T, Benedetto C, Hollo S, Segoloni GP: Is pregnancy-related acute renal failure a disappearing clinical entity? Ren Fail. 1996;18:575-84.
Prakash J, Niwas SS, Parekh A, Pandey LK, Sharatchandra L, Arora P, Mahapatra AK: Acute kidney injury in late pregnancy in developing countries. Ren Fail. 2010;32:309-13.
Fakhouri F, Vercel C, Fre´meaux-Bacchi V. Obstetric Nephrology: AKI and Thrombotic Microangiopathies in Pregnancy Clin J Am Soc Nephrol. 2000;7:2100-6.
Gammill HS, Jeyabalan A. Acute renal failure in pregnancy. Crit Care Med 2005;33:S372‑84.
Pertuiset N, Grünfeld JP. Acute renal failure in pregnancy. Baillieres Clin Obstet Gynaecol. 1994;8:333‑51.
Chugh KS. Etiopathogenesis of acute renal failure in the tropics. Ann Natl Acad Med Sci (India). l987;23:88‑99.
Kilari SK, Chinta RK, Vishnubhotla SK. Pregnancy related acute renal failure. J Obstet Gynecol India. 2006;56:308‑10.
Prakash J, Tripathi K, Malhotra V, Kumar O, Srivastava PK. Acute renal failure in eastern India. Nephrol Dial Transplant. 1995;10:2009‑12.
Machado S. Acute kidney injury in pregnancy: a clinical challenge. J nephrol. 2012;25(01):19-30.
Mahesh E, Puri S, Varma V, Madhyastha PR, Bande S, Gurudev KC. Pregnancy-related acute kidney injury: An analysis of 165 cases. Indian J Nephrol. 2017;27:113-7.
Prakash J, Tripathi K, Pandey LK, Sahai S, Usha, Srivastava PK: Spectrum of renal cortical necrosis in acute renal failure in eastern India. Postgrad Med J. 1995;71:208-10.
Pahwa N, Bharani R, Kumar R. Post-partum acute kidney injury. Saudi J Kidney Dis Transpl. 2014;25(6):1244-7.
Godara SM, Kute VB, Trivedi HL, Vanikar AV, Shah PR, Gumber MR, et al. Clinical profile and outcome of acute kidney injury related to pregnancy in developing countries: a single-center study from India. Saudi J Kidney Dis Transpl. 2014;25(4):906-11.
Goplani KR, Shah PR, Gera DN, Gumber M, Dabhi M, Feroz A et al. Pregnancy-related acute renal failure: A single-center experience. Indian J Nephrol. 2008;18(1):17-21.
Krishna A, Singh R, Prasad N, Gupta A, Bhadauria D, Kaul A et al. Maternal, fetal and renal outcomes of pregnancy – associated acute kidney injury requiring dialysis. Ind J Nephrol. 2000;25(2):77-81.
Nazar MS, Shah AR, Wani IA, Reshi R, Banday KA, Bhat MA et al. Pregnancy related acute kidney injury: A single center experience from the Kashmir Valley. Indian J Nephrol. 2008;18(4):159-161.
Gopalakrishnan N, Dhanapriya J, Muthukumar P, Sakthirajan R, Dineshkumar T, Thirumurugans et al. Acute kidney injury in pregnancy--a single center experience. Ren Fail. 2015;37(9):1476-80.
Chugh KS, Singhal PC, Kher VK, Gupta VK, Malik GH, Narayan G, Datta BN. Spectrum of acute cortical necrosis in Indian patients. Am J Med Sci. 1983;286:10-20.
Rao S, Jim B. Acute Kidney Injury in Pregnancy: The Changing Landscape for the 21st Century. Kidney Int Rep. 2018;1-18.
Prakash J, Tripathi K, Pandey LK, Gadela SR, Usha. Renal cortical necrosis in pregnancy-related acute renal failure. J Indian Med Assoc. 1996;94(6):227-9.
Selcuk NY, Onbul HZ, San A, Odabas AR. Changes in frequency and etiology of acute renal failure in pregnancy (1980-1997) Ren Fail. 1998;20:513-7.
Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33:130-7.
Powles K, Gandhi S. Postpartum hypertension. CMAJ. 2017;189:E913.
Tangren JS, Powe CE, Ankers E. Pregnancy outcomes after clinical recovery from AKI. J Am Soc Nephrol. 2017;28:1566-74.
Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol. 2009;113:1299-306.
Machado S, Figueiredo N, Borges A. Acute kidney injury in pregnancy: a clinical challenge. J Nephrol. 2012;25:19-30.
