Risk factors and fetomaternal outcome in pregnancy-related acute kidney injury
Introduction: Pregnancy-related acute kidney injury (PRAKI) is acute kidney injury (AKI) occurring during pregnancy, labor, and postpartum period. AKI is defined as suddenly impaired kidney function with the retention of nitrogenous and other waste products. In high population country like India, no...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Journal of Family Medicine and Primary Care |
| Subjects: | |
| Online Access: | http://www.jfmpc.com/article.asp?issn=2249-4863;year=2023;volume=12;issue=12;spage=3346;epage=3350;aulast=Sandilya |
| _version_ | 1797232677468766208 |
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| author | Shipra Sandilya Kumari Usha Rani Rajesh Kumar |
| author_facet | Shipra Sandilya Kumari Usha Rani Rajesh Kumar |
| author_sort | Shipra Sandilya |
| collection | DOAJ |
| description | Introduction: Pregnancy-related acute kidney injury (PRAKI) is acute kidney injury (AKI) occurring during pregnancy, labor, and postpartum period. AKI is defined as suddenly impaired kidney function with the retention of nitrogenous and other waste products. In high population country like India, not all deliveries are done tertiary care. Even not all are registered one if delivery is conducted at a hospital setup. The majority of patients are being managed by available obstetrician at local places. Early diagnosis and timely management of complications related to pregnancy are very important to avoid PRAKI. We aim to study maternal risk factors and fetomaternal outcome in PRAKI. Materials and Methods: A prospective study is conducted between 2021 and 2022 in the Department of Obstetrics and Gynaecology, VMMC, and Safdarjung Hospital, New Delhi. For antenatal and delivered women up to 6 weeks, 50 patients were recruited according to KDIGO (Kidney Disease International Global Outcomes) criteria. Patients were followed with CBC, serum electrolytes, serial KFT, urine input/output monitoring, and USG-KUB. Dialysis was done if indicated. Complete renal recovery was considered if S.Cr ≤1.0 mg/dl within 6 weeks of diagnosis of AKI. For statistical significance, a P value of less than 0.05 was considered. Results: The majority of patients were unbooked, 21–25 years of age, and belonged to lower socioeconomic status (54%). Risk factors were: preeclampsia (28%), puerperal sepsis (24%), PPH (20%), abruption (14%), pyelonephritis (4%), acute gastroenteritis (4%), gestational hypertension with superimposed preeclampsia (2%), antepartum eclampsia (2%), and thrombotic microangiopathy (2%). Hemodialysis is required in 23 (46%). Complete renal recovery was seen in 40 (80%) and partial renal recovery in 3 (6%). Maternal mortality was 14% and causes were: puerperal sepsis (57%), preeclampsia with severe features with MODS (29%), and antepartum eclampsia with hepatorenal failure (14%). Fetal outcome: 76% live birth, 24% intrauterine death, and 16% early neonatal death. Conclusion: Most common risk factors for PRAKI are preeclampsia followed by puerperal sepsis and PPH where all are preventable causes. |
| first_indexed | 2024-04-24T16:04:05Z |
| format | Article |
| id | doaj.art-83c3808c98584a19970d1a316523a4ad |
| institution | Directory Open Access Journal |
| issn | 2249-4863 |
| language | English |
| last_indexed | 2024-04-24T16:04:05Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Family Medicine and Primary Care |
| spelling | doaj.art-83c3808c98584a19970d1a316523a4ad2024-04-01T06:00:31ZengWolters Kluwer Medknow PublicationsJournal of Family Medicine and Primary Care2249-48632023-01-0112123346335010.4103/jfmpc.jfmpc_924_23Risk factors and fetomaternal outcome in pregnancy-related acute kidney injuryShipra SandilyaKumari Usha RaniRajesh KumarIntroduction: Pregnancy-related acute kidney injury (PRAKI) is acute kidney injury (AKI) occurring during pregnancy, labor, and postpartum period. AKI is defined as suddenly impaired kidney function with the retention of nitrogenous and other waste products. In high population country like India, not all deliveries are done tertiary care. Even not all are registered one if delivery is conducted at a hospital setup. The majority of patients are being managed by available obstetrician at local places. Early diagnosis and timely management of complications related to pregnancy are very important to avoid PRAKI. We aim to study maternal risk factors and fetomaternal outcome in PRAKI. Materials and Methods: A prospective study is conducted between 2021 and 2022 in the Department of Obstetrics and Gynaecology, VMMC, and Safdarjung Hospital, New Delhi. For antenatal and delivered women up to 6 weeks, 50 patients were recruited according to KDIGO (Kidney Disease International Global Outcomes) criteria. Patients were followed with CBC, serum electrolytes, serial KFT, urine input/output monitoring, and USG-KUB. Dialysis was done if indicated. Complete renal recovery was considered if S.Cr ≤1.0 mg/dl within 6 weeks of diagnosis of AKI. For statistical significance, a P value of less than 0.05 was considered. Results: The majority of patients were unbooked, 21–25 years of age, and belonged to lower socioeconomic status (54%). Risk factors were: preeclampsia (28%), puerperal sepsis (24%), PPH (20%), abruption (14%), pyelonephritis (4%), acute gastroenteritis (4%), gestational hypertension with superimposed preeclampsia (2%), antepartum eclampsia (2%), and thrombotic microangiopathy (2%). Hemodialysis is required in 23 (46%). Complete renal recovery was seen in 40 (80%) and partial renal recovery in 3 (6%). Maternal mortality was 14% and causes were: puerperal sepsis (57%), preeclampsia with severe features with MODS (29%), and antepartum eclampsia with hepatorenal failure (14%). Fetal outcome: 76% live birth, 24% intrauterine death, and 16% early neonatal death. Conclusion: Most common risk factors for PRAKI are preeclampsia followed by puerperal sepsis and PPH where all are preventable causes.http://www.jfmpc.com/article.asp?issn=2249-4863;year=2023;volume=12;issue=12;spage=3346;epage=3350;aulast=Sandilyaacute kidney injury (aki)postpartum hemorrhage (pph)preeclampsiapregnancypregnancy-related acute kidney injury (praki) |
| spellingShingle | Shipra Sandilya Kumari Usha Rani Rajesh Kumar Risk factors and fetomaternal outcome in pregnancy-related acute kidney injury Journal of Family Medicine and Primary Care acute kidney injury (aki) postpartum hemorrhage (pph) preeclampsia pregnancy pregnancy-related acute kidney injury (praki) |
| title | Risk factors and fetomaternal outcome in pregnancy-related acute kidney injury |
| title_full | Risk factors and fetomaternal outcome in pregnancy-related acute kidney injury |
| title_fullStr | Risk factors and fetomaternal outcome in pregnancy-related acute kidney injury |
| title_full_unstemmed | Risk factors and fetomaternal outcome in pregnancy-related acute kidney injury |
| title_short | Risk factors and fetomaternal outcome in pregnancy-related acute kidney injury |
| title_sort | risk factors and fetomaternal outcome in pregnancy related acute kidney injury |
| topic | acute kidney injury (aki) postpartum hemorrhage (pph) preeclampsia pregnancy pregnancy-related acute kidney injury (praki) |
| url | http://www.jfmpc.com/article.asp?issn=2249-4863;year=2023;volume=12;issue=12;spage=3346;epage=3350;aulast=Sandilya |
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