Pattern and Outcome Trends in Pregnancy Related Acute Kidney Injury over 35 years: A study of 2,275 cases

Abstract

Objectives: Pregnancy related acute kidney injury (PRAKI) is a serious complication during or soon after child birth where sudden onset renal dysfunction occurs, often requiring renal replacement therapy. Its incidence and prevalence vary widely across the globe. We, at a tertiary renal care unit, while providing all renal care free of cost to patient, receive large number of patients from all over country. Present study which expands over 35 years describes largest number of PRAKI series, highlighting causes, course of illness and outcome.

Methodology: This is a retrospective cohort performed at Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan. From January 1990 to December 2024 case records of all patients who satisfy KDIGO definition of AKI, developing it during pregnancy or soon after child birth, were reviewed and data collected and analyzed on SPSS Version26.0.

Results: During this 35-year period, total 2,275 cases of PRAKI were seen at this institution, these were 24% of total AKI registered here. Mean age was 28.46 ±5.83 (range from 15-46 years). Oligo-anuria was frequent symptom found in 90.19%. main causes were peripartum excessive blood loss, intra uterine fetal death, sepsis, pre-eclampsia/ eclampsia, lower segment caesarean section and hemolytic uremic syndrome/ thrombotic Microangiopathy. The last has shown rising trends over last decade. Many women had more than one contributing factor. Renal replacement therapy required in 94%. Complete renal recovery was seen in 27%. End stage renal failure in 19%, Chronic kidney disease in 29% and follow up was missing in 14% patients. Overall mortality was 248 (10.9%), and was high in patients who were anuric, had abnormal platelet counts, and/or marked liver dysfunction and/or deranged coagulation, and/or required mechanical ventilation. Many of those who died had combination of the mentioned parameters.

Conclusion: PRAKI is serious complication of pregnancy, it requires immediate address to the problem. Its markedly different (high) prevalence in developing world indicates impact of socioeconomic status and provision of basic health services in this part of world. Training of health care providers at basic health units with improved antenatal care, skilled birth attendance, timely addressing the problem and referrals to appropriate services must be considered seriously.