TRENDS IN PREGNANCY RELATED ACUTE KIDNEY INJURY - AT A TERTIARY CARE CENTRE

8 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-1858, Poster Board= SAT-366

Introduction:

Acute Kidney Injury(AKI) that occurs during pregnancy or within 42 days after giving birth is referred to as pregnancy-related acute kidney injury(PRAKI).Diagnosing PRAKI early on is still difficult. The proposed PRAKI prevention bundle consists of baseline renal parameters and blood pressure monitoring from day 1, avoidance of nephrotoxic drugs, hourly urine output monitoring during delivery and the first few days after delivery, and seek early nephrology guidance.

Methods:

We enrolled 81 pregnant and postpartum (within 42 days) patients admitted with PRAKI in our hospital from August 2022 to July 2024 for a period of 2 years. Patients with Chronic kidney disease (CKD) were excluded

Results:

The mean age in our patients were 26.4 ± 4.71 years. 96.3 % were booked pregnancy (n=78). Literacy rate was 42% (n=34). Delayed referrals were 13.5% (n=11). Gravida status - Primigravida being 43.5% (n=35) and multigravida was 56.8%(n=46). 79 patients had institutional delivery and 2 patients had home delivery. PRAKI seen during postpartum, third trimester, second trimester and first trimester were 31, 36, 8 and 6 respectively. Blood transfusion was given to all patients who had severe blood loss during delivery which is 23.4% (n=19). Sepsis, mostly hospital acquired was seen in 28% of patients(n=23). PRAKI associated with obstetric complications during delivery such as hemorrhage or surgical complications were 19.7% (n=16).

Mean peak creatinine and mean creatinine at discharge were 2.268 ± 1.26 mg/dl and 1.10 ± 0.90 mg/dl respectively. Mean hospital duration of stay was 12.26 ± 6.35 days. Mean serum creatinine at 90 days (n=78) was 1.04 ± 0.98.

Ten patients had dialysis requiring AKI. Three patients were spaced off from hemodialysis while two of them recovered from AKI and one of them progressed to CKD. Three patients progressed to End Stage renal disease. One patient lost to follow up. Mortality in three patients. There is significant association of TMA with CKD progression (p=0.004).

Four patients had TMA diagnosed by renal biopsy done in postpartum. One patient had mutation in complement factor H. Two patients had class 4 lupus nephritis associated with TMA. Other patient had sepsis associated TMA who recovered completely. Renal biopsy was done in 7 patients.

FETAL

OUTCOMES

(n=81)

Abortion

6(7.4%)

IUD

7(8.6 %)

Stillbirth

4(4.9 %)

Live birth requiring NICU

28 (34.6 %)

Live birth

(No NICU admission)

36(44.4 %)

MATERNAL

OUTCOMES

(n=81)

Discharged

78(96.3%)

Died

3(3.7%)

 

 

 

RENAL

OUTCOMES

(AT DISCHARGE)

(n=81)

Complete

Recovery

56(69.1%)

Dialysis independent with residual renal function

17 (21%)

Dialysis dependent

5 (6.1%)

Death during treatment

3(3.7%)

 

RENAL

OUTCOMES

(AT 3 MONTHS)

(n=78)

Complete

Recovery

69(85.2%)

Dialysis independent with residual renal function

5 (6.2%)

Dialysis dependent

3(4.9%)

Lost to follow up (n=1)

 

OBSTETRIC

OUTCOMES

(N=81)

NVD

n=15

NVD assisted

n=1

Emergency LSCS

n= 49

 

 

Emergency LSCS with hysrectomy

n=5

Elective LSCS

n=5

causes of PRAKI

Conclusions:

The incidence of PRAKI is 3.5 per 1000 pregnancy. Our study highlights the changing trend in PRAKI and how far we have come across from decades of sepsis being the main and only cause for maternal mortality and morbidity. This study has helped in epidemiological data analysis about PRAKI in our setup.

I have no potential conflict of interest to disclose.

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