Pregnancy Associated Acute Kidney Failure: Early clinical insights

Abstract

Objective:

The goal is to characterise the clinical spectrum of acute renal illness associated with pregnancy and its effects on maternal and foetal morbidity and mortality.
Methodology: This Case-series was conducted at Department of Nephrology, Akbar Niazi Teaching Hospital, Islamabad from February 2022–February 2024. Pregnancy-related acute renal failure has been defined as abrupt onset oligoanuria or a blood creatinine level more than 1.5 milligrammes% on two consecutive occasions. Patients who had preexisting CKD had been excluded from the research.

Results: 350 people suffering from acute renal failure received medical care in a single year. A total of 55 women met the PR-ARF criterion. The incidence of PR-ARF reported 50/350 (14.2%). The clinical spectrum includes 20/51 (39.2%) instances of PIH, PET, and eclampsia, with or without sepsis/DIC. 7/55 (12.5%) developed acute tubular necrosis, whereas 9/55 (16.3%) developed puerperal sepsis. 12/55 (21.8%) patients experienced sepsis in addition to ATN, and three of them had a septic abortion. RPGN 1/55 (1.8%), and early cortical necrosis 1/55 (1.8%). Pregnancy-related ARF was most common in the third trimester/postpartum period, accounting for 45/55 (81.8%). It was followed by vaginal birth in 31/55 (56.36%) patients, 15/55 (27.2%) after a caesarean delivery, and 3/55 (5.4%) following septic abortion with Dai management. Dai (the conventional delivery attendant) handling was seen in 17/55 (30.9%).Antenatal care was unavailable to 38/55 (69.0%). Maternal outcomes revealed that 16/55 (29.0%) individuals died, 25/55 (45.5%) recovered completely, 2/55 (3.6%) recovered partially, and 4/55 (7.2%) had permanent renal failure. The outcome was uncertain in 3/55 (5.4%).

Conclusion: The most prevalent cause of pregnancy-related acute kidney damage is PIH, which is often accompanied with additional risk factors such as abruption, IUD, DIC, and RPOC. In PR-ARF, sepsis is the primary contributing factor. The majority of patients did not get prenatal care or Dai management. Pregnancy-related acute renal failure presents a significant maternal death and morbidity rate.

Keywords: Pregnancy related acute kidney failure, renal failure.