Introduction:
The burden of renal admissions in a tertiary hospital in Sierra Leone is estimated to be 2.7%, predominantly affecting younger patients with a female preponderance. The common causes of acute kidney injury were sepsis and hypovolemia (Coker et al., 2022) . A systematic review and meta-analysis reported a pooled incidence of pregnancy-related acute kidney injury (PR-AKI) at 2.0% with preeclampsia being the most common cause (Trakarnvanich et al., 2022). The pregnancy-related acute kidney injury accounts for 5–27% of all cases of acute kidney injury among adults in Africa, a value that is far higher than that in developed nations (Shalaby and Shemies, 2022a). Sierra Leone still grapples with unique challenges of high maternal mortality rate and limited research on kidney impairment. As a result, there remains a notable scarcity of information regarding the clinical presentations, characteristics, and outcomes of Pregnancy-related AKI, posing a considerable obstacle to effective management and prevention strategies during pregnancy. Addressing these gaps in knowledge is critical to improve maternal health outcomes, especially in resource-constrained settings, and to develop targeted interventions that mitigate the risk and impact of PR-AKI.
Methods:
Methods: The study was carried out in 2 hospitals (Connaught Hospital and Princess Christian Maternity Hospital) that are part of the University of Sierra Leone Teaching Hospitals Complex (a complex of 6 hospitals). In this study, we defined Pregnancy-related acute kidney injury as serum creatinine ≥ 1.5 mg/dl or urine output ≤0.3 ml/kg/hour; with symptoms lasting for less than 4 weeks occurring during pregnancy or puerperium. Patients with pre-existing kidney disease were excluded from the study and those missing more than 20% of study variables were also excluded from the study. This study employed a retrospective study design using a well-designed proforma for data collection during the study period from January 2022 to December 2022. Information collected from the study proforma included sociodemographic details: Age (years), gender, level of education, and marital status; status on antenatal care: number of pregnancies, the maternal and foetal outcome of pregnancy, and when AKI was diagnosed; common causes of PR-AKI: Sepsis, Pre-eclampsia, Eclampsia, Post Partum Haemorrhage, Nephrotoxic Drugs and others; clinical characteristics of PR-AKI such as features of underlying infection or systemic inflammatory response syndrome, volume overload, symptoms of uraemia, obstructive and irritating urinary symptoms; dipstick urinalysis findings; length of hospitalisation, whether patient was discharged Home or discharged against medical advice (DAMA) and Death.
Results:
Thirty-five patients (35) were enrolled into the study, with a mean age of 28.6 years. 82.8% were of young age groups less than 35 years old. Sepsis (30.4%), pre-eclampsia (28.25%), post-partum haemorrhage (7.6%), and use of nephrotoxic drugs (22.8%) were recorded as predominant causes of PR-AKI. Sixty-percent (60%) of cases occurred in the first 2 pregnancies; 86% were diagnosed in antenatal or puerperal periods; the common comorbidities were systemic hypertension (37%) and Hepatitis B Co-infection (25.7%). Common clinical presentations were fever (62.9%), oedema (85.7%), reduction in urine output (85.7%), flank pain (37.1%), the passage of frothy urine (22.5%), vomiting (40.0%) and hypertension (54.3%). Sixteen patients (45.7%) required dialysis; 77.1% were discharged home, and mortality recorded was (5.7%)
Conclusions:
The study showed that PR-AKI is common in young patients in their first and second pregnancies with favourable outcomes. Sepsis, pre-eclampsia, and the use of nephrotoxic drugs were the common causes of PR-AKI in this environment. Systemic hypertension was a common pre-existing condition. There is need for a prospective research and genomic evaluation of this cohort of patients in our environment.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.