Aetiology and Maternal Outcome in Pregnancies complicated by Acute Kidney Injury a Tertiary Care Single Centre Experience
Objective: To determine the frequency, aetiology and Renal and maternal outcomes of Pregnancy-Related AKI in Kharian.
Methodology: This prospective observational study was carried at CMH Kharian between 1st January and 30th June 2019. All participants had serum creatinine tested at enrolment and were inquired specifically about any history of renal disease or any renal procedure in the recent past (at least 3 months). Those mothers who developed creatinine above normal range (> 110 umol/L) during study period or decreased urine output underwent serial assessment and evaluation in addition to investigations for determining aetiology of kidney injury. They were managed by Gynaecology and Nephrology teams in collaboration with each other. AKI was diagnosed and staged by Kidney Disease Improving Global Outcomes (KDIGO) criteria. Primary outcomes were the Frequency proportion and aetiology of AKI. Secondary outcomes were in-hospital and post discharge maternal mortality, need for dialysis, renal recovery and length of stay in-hospital.
Results: A total of 720 patients were included in our study. Mean maternal age was 27.5 (+ 6.447) years. A substantial n=504 patients had uneventful pregnancy course from kidney perspective but a surprising n = 216 (30%) of mothers were found to have renal injury of varying severity and types. While most of the patients recovered completely, a small n=24 (11 %) number of patients required one or more dialysis. Most of these dialysis patients recovered, however, another significant portion n=23 (11%) remained dialysis dependent permanently. Out of n= 216 patients in AKI n= 120 ((56%) belonged to lower Socio Economic class which comprised only 27% of the total study population. It was followed by middle class n=72 (33%). Pregnancy related AKI (pr-AKI) was least common in Upper socio-economic class with only n= 24 (11%) patients in this class. Regarding maternal outcomes n= 166 (77%) mothers recovered completely. However, n= 42 (20%) patients had some degree pf azotaemia including a few cases requiring permanent renal replacement therapy. Importantly enough 7 (3%) mothers died due to causes related to renal dysfunction and dialysis.
Conclusions: The Pregnancy related-AKI and its complications have alarmingly high rate in the population living around Grand trunk road. Post-partum haemorrhage (PPH) in addition to Sepsis is the leading causes of Pregnancy related-AKI. With tertiary nephrology and obstetric care the most of AKI resolved with no residual effect but substantial number of patients developed CKD which culminated in dialysis in the future, placing a huge financial and health care burden on family and Health care resources.
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