Introduction:
Pregnancy-related acute kidney injury (PRAKI) is a significant clinical challenge, characterized by a sudden decline in renal function that can lead to severe maternal and fetal complications. Our study aims to explore its clinical characteristics, precipitating factors, etiology, histopathological patterns and outcomes.
Methods:
Retrospective observational study conducted at our institute between 2010- 2023. Medical records of 161 patients of PRAKI with renal biopsy were analysed.
Results:
Our cohort included 161 patients with a mean age of 34.76.4 years. Seventy-four patients (46%) were primigravida. Nine patients (5.6%) had chronic hypertension and 16 patients (9.8%) had pre-eclampsia. LSCS (67.1%) was the predominant mode of delivery. The majority (82.6%) of PRAKI cases were diagnosed in the post-partum period. Sepsis (52.2%), bleeding (38.5%) and hypotension (32.3%) were among the triggering factors. The majority of fetuses were full-term (62.1%) and 12.4% of fetuses were preterm. Microangiopathic hemolytic anaemia and schistocytes were seen in 18.6% of patients. The aetiology of PRAKI were sepsis (42.2%), P-aHUS (29.2%), obstetric haemorrhage (16.1%), hypertensive disorders of pregnancy(1.2%), lupus nephritis(0.6%) and other glomerulonephritis (10.5%). The most common biopsy findings were cortical necrosis (55.2%) followed by Thrombotic microangiopathy (27.9%). Twenty-one patients (33.7%) received steroid therapy while plasmapheresis and plasma infusion were given to 35 patients (42.6%) and 21 patients (25.2%) respectively. 151 patients (93.8%) required dialysis at admission. 127 patients (78.8%) showed no recovery out of which 105 patients (65.2%) remained dialysis-dependent on a median follow-up of 326 days (IQR 192-1126). On follow-up, 15 patients (9.3%) succumbed to the illness.
Features associated with poor recovery were fever, oliguria, anuria, dialysis requirement at admission and cortical necrosis on histopathological analysis (P <0.005). PRAKI cases diagnosed in the first trimester and having acute tubular necrosis on renal biopsy showed recovery. (P <0.005)
Conclusions:
PRAKI has a detrimental effect on maternal renal health as three-fourths does not show improvement. Clinical and histopathological features may aid in prognostication and definitive diagnosis to provide tailored therapy
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.