Introduction:
Acute kidney injury (AKI) is a serious complication in pregnancy, resulting in significant maternal morbidity, mortality and fetal loss. Although the incidence of pregnancy-related acute kidney injury (PRAKI) has decreased in developed countries, it is still challenging in developing nations.
Aim – 1. To evaluate the incidence, clinical characteristics ,predictor and outcomes of acute kidney injury in Indian population.
2. To estimate acute to chronic kidney disease progression in PRAKI
3. To study the role of oxidative and carbonyl stress in PRAKI
Methods:
Prospective observational study was conducted in PRAKI patients admitted to Nilratan Sircar Medical College & Hospital, a tertiary care hospital in eastern part of India. AKI was diagnosed on RIFLE criteria. Patients were analyzed on the basis of demographic data, detailed history, clinical examination, and laboratory investigations. Methylglyoxal (carbonyl stress), advanced oxidation protein product (AOPP)(for oxidative stress) was measured and plasma and urinary NGAL, Cystatin C, KIM-1, and TGFβ1 were assessed. Biopsy was done in non resolving AKI. They were followed up at 7day, one and 3 months of discharge. All data were analyzed in standard statistical tool.
Results:
A total of 225 PRAKI patients were included in the study having a mean age of 24.4 ± 4.73 years of which about 40% were primigravida. Overall incidence was 4 %. Most of the AKI (74.6%) was noted in postpartum period. The leading cause of AKI includes sepsis (54.6%), followed by pre-eclampsia/ eclampsia (29.7%) and postpartum hemorrhage (16.8%). The major presentation was oligoanuria (75.5%) followed by anemia , thrombocytopenia. Renal biopsy was done in 25 cases of which acute cortical necrosis was predominant followed by ATN and TMA . Hemodialysis required in 40% patients with mean HD 6.94 +/- 9 session. Complete recovery was in about 69.8%. About 10.6% was diagnosed CKD in follow up. Live births occurred in 72% of patients . Mortality rate observed was 20%. Sepsis was the major cause of death. At multivariate level sepsis, PPH, anemia, thrombocytopenia and leucocytosis were found to be the significant predictor of development of PRAKI. In univariate analysis, low platelet count, higher serum creatinine, increased dialysis and histopathologically presence of cortical necrosis predicted the progression to chronic kidney disease. Methyl glyoxate and advance oxidation protein product were measured showed linear correlation with adverse outcome. Kidney injury molecule was promising biomarker for predicting CKD progression.
Conclusions:
In PRAKI though maternal, foetal and renal outcome is improving the absolute death and irreversible damage of kidney is quite high and need more biomarker based study for early intervention.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.