SPECTRUM OF POST-PARTUM ACUTE KIDNEY INJURY: A TERTIARY CARE CENTRE PERSPECTIVE

Introduction:

Acute kidney injury (AKI) occurring during pregnancy or the postpartum period (PP-AKI) is a severe obstetric complication that carries a high risk of maternal morbidity and mortality. The incidence of AKI during pregnancy varies widely in developing countries, ranging from 0.02 to 11%. We aimed to provide clinical spectrum and outcomes of obstetric related AKI.

Methods:

The study was a single centre, prospective, observational cohort study of patients with CA-AKI who were admitted at PGIMER, Chandigarh, India. Age ≥18 years and presence of CA-AKI were inclusion criteria. Underlying CKD, glomerulonephritis, obstructive uropathy, decompensated chronic liver disease, heart failure, autoimmune diseases, malignancy or solid organ transplant recipients were excluded. Patients were scheduled for 1 and 4 month follow-up after hospital discharge. Clinical and laboratory data were recorded at baseline,  at 1 and 4 months after hospital discharge to assess the renal outcome. Renal recovery was defined at eGFR≥ 60 ml/min/1.73m2 at ≥3 months.

Results:

1973 patients were screened out of which 818 were enrolled (figure 1). 139  (16.9%) patients had obstetric AKI. Out of 139, 14 (10.1%) expired during hospitalization and 4 (2.9%) patients left against the medical advice. The mean age of study population was 27.1±5.0 years. Hypertension and diabetes mellitus were reported in 12.2%, and 2.9% patients. Upon admission, 71.2% patients were oliguric, and 61.9% patients were dialysis dependent. Mean duration of hospital stay was 14.5 ± 8.0 days. Post-partum hemorrhage (24%) was the most common cause of AKI (figure 2) followed by sepsis (21%), and pre-eclampsia (12%).  39 (28.0%) had acute cortical necrosis, with 2 cases confirmed by renal biopsy and 37 by computed tomography scan. 4 patients underwent renal biopsy, 2 had acute cortical necrosis, 1 had acute interstitial nephritis and 1 had acute tubular necrosis.

Out of 120 patients who were eligible for 4 month visit, only 60% had follow up data. 17.8% were dialysis dependent at 1 month after discharge. At the 4-month follow-up, the overall rates of complete renal recovery (eGFR≥60 ml/min/1.73m2), partial recovery (eGFR <60 ml/min/1.73m2 and not requiring dialysis), and dialysis dependency were recorded in 51.4%, 31.9%, and 16.7% respectively.

Conclusions:

Obstetric AKI is still common in tertiary care referral centers. Approximately, 10% patients die due to AKI. The follow up rates are poor at around 60%. Amongst those with follow up, 16% were still dialysis dependent and 32% had eGFR <60 ml/min/1.73m2. These data reflect poor outcomes after obstetric AKI.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.