Introduction:
Background and Aims:
Acute kidney injury (AKI) during pregnancy and the postpartum period is a significant cause of maternal morbidity, mortality, and fetal loss, particularly in developing countries. Pregnancy-related acute kidney injury (PRAKI) remains common. This study aims to evaluate the role of renal biopsy in determining the etiology, guiding management, and predicting outcomes in PRAKI.
Methods:
Methods:
A retrospective review of 249 native renal biopsies from patients with PRAKI at a tertiary care center in India between January 2010 and December 2023 was conducted. Biopsies were performed in patients with non-recovery within 10 days or those with active urinary sediment. Histopathological slides were reviewed, and clinical data and laboratory findings were collected. Patient outcomes were tracked for one year post-hospitalization to assess recovery.
Results:
Results:
The mean age of the 249 patients was 26.5 ± 4.6 years. Surgical interventions included cesarean sections in 61%, vaginal deliveries in 23.2%, and obstetric hysterectomies in 1.2%. Spontaneous termination occurred in 12.8%. The leading causes of AKI were sepsis (40.6%), hemorrhage (24.5%), preeclampsia (11%), and others (23%). Fetal loss occurred in 20.08% of cases.
Renal biopsy results revealed:
Patchy cortical necrosis in 36%
Diffuse cortical necrosis in 23%
Acute tubular necrosis in 19%
Thrombotic microangiopathy in 3%
Acute interstitial nephritis in 15%
IgA nephropathy in 3%
Lupus nephritis in 1%
Of the patients, 97% required multiple hemodialysis sessions, and 2.8% underwent plasmapheresis. During hospitalization, 7.2% of patients died due to sepsis with shock. At one-year follow-up, 45.02% achieved complete recovery, 21.21% had partial recovery, and 36.36% required continuous renal replacement therapy. Two patients underwent successful live-related renal transplantation.
Conclusions:
Discussion and Conclusion:
PRAKI is a critical complication during pregnancy, with sepsis being the most common cause, followed by hemorrhage and preeclampsia. Renal biopsy plays an essential role in diagnosing underlying pathologies, particularly in non-recovery cases. Our study, one of the largest on PRAKI with documented renal histology, shows acute cortical necrosis as the most frequent finding, followed by acute tubular necrosis. The high incidence of cortical necrosis may reflect the severity of cases referred to our tertiary center. Biopsies help diagnose conditions like thrombotic microangiopathy and other glomerular and interstitial diseases, guiding treatment. Early diagnosis and intervention are crucial for improving maternal and fetal outcomes in PRAKI.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.