Aetiology and Maternal Outcome in Pregnancies complicated by Acute Kidney Injury; A Tertiary Care Single Centre Experience
Objective: This study aims to determine the aetiology and maternal outcomes of Pregnancy-Related AKI.
Methodology : This Prospective observational study was carried at CMH Kharian in the department of nephrology and department of gynae and obs between January to June 2019. Pregnant Women with normal renal profile at the time of enrolment in the study and no previous history of kidney disease or renal procedure in the recent past (at least 3 months) before conception were included. 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 the normal range (> 110 umol/L) during the study period or decreased urine output underwent serial assessment and evaluation in addition to investigations for determining aetiology of kidney injury. AKI was diagnosed and staged by Kidney Disease Improving Global Outcomes (KDIGO) criteria.
Results : A total of 720 patients were included. The mean maternal age was 27.5 (+ 6.447) years. A substantial n=504 patients had an uneventful pregnancy course from a kidney perspective but a surprising n = 216 (30%) of mothers developed renal injury of varying severity. While most of the patients recovered completely, a small n=24 (11%) number of patients required dialysis. Most of these dialysis patients recovered completely, however, a significant portion n=23 (11%) remained dialysis-dependent permanently. (CKD)
A major chunk (56%) of our patients came from Lower Socio Economic Class. Regarding maternal outcomes n= 166 (77%) mothers recovered completely. However n= 42 (20%) patients had some degree pf azotaemia. Importantly enough 7 (3%) mothers died due to causes related to renal dysfunction and dialysis.
Conclusions: The Pregnancy related-AKI and its complications have an alarmingly high rates 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 AKI resolved with no residual effect but a 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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