Introduction:
Pregnancy related AKI is a large public health problem. A heterogenous disease entity that occurs due to a multitude of etiologies. Irrespective of etiology it remains an important cause of maternal and fetal mortality and morbidity. There is a decreasing incidence of P.AKI in developing countries reflective of the advancement in maternal care. However there has been a recent onset increase in the incidence of pregnancy related AKI. This increasing trend is more due to underlying maternal risk factors. Traditional causes of P.AKI-septic abortions and puerperal sepsis have largely been replaced by hypertensive diseases (Pre-eclampsia, eclampsia, HELLP) and TMA (TTP, atypical hemolytic uremic syndrome, aHUS). Pregnancy related AKI-serious obstetric complication having long term renal , cardiovascular and neurocognitive consequences persisting beyond post partum period.
Methods:
Twelve cases of PR-AKI with no prior history of renal dysfunction underwent a series of routine and specialised non-invasive investigations including imaging as per requirement clinically. Eleven of them, underwent renal biopsy following failure of recovery of renal function after three weeks. Also application of treatment modalities-hemodialysis/plasmapharesis was recorded. Outcomes were in terms of renal recovery-partial/complete/non-recovery were recorded. Recovery of extra-renal organs was recorded. Long term follow up of these patients upto 6 months after discharge on monthly basis was done.
Results:
Eleven were primipara, belonging to 20-28 years of age, while two were below 20 years. Nine patients underwent LUCS due to varied indications. All presented in post partum period within 12-24 hours post delivery requiring hemodialysis. Hematologically thrombotic microangiopathy were present in all. LFT showed evidence of conjugated hyperbilirubinemia in two and transaminitis in all. Coagulation and immunological profile were normal.C3 level was low in three. Six patients had cardiac involvement, while one had subarachnoid hemorrhage.Renal biopsy showed TMA in six patients and ACN along with features of TMA in five. After 7 sessions of plasmapheresis four patients had complete recovery. CD46 mutation was detected in one patient
Conclusions:
A paradigm shift in timing and etiology of recent rise in PR-AKI. Despite improvement in antenatal care and institutional deliveries rising number of cases with more atypical presentations. Predominantly occurring in post-partum period -extremely vulnerable period for thrombotic microangiopathic disorders. Also, etiologies other than sepsis need consideration especially pregnancy-TMA. A more diverse extra-renal involvement predominantly cardiac and hepatic .Initial leukocytosis mimics sepsis and hinders diagnostic approach. Greater need for non-invasive markers. Despite literature mentioning Pregnancy-associated HUS a rare cause in view of the recent trend of rising post-partum AKI with hematological ,severe renal as well as extra-renal involvement -a high index of suspicion is needed for detection of this entity-whose timely detection and therefore intervention can change the course of this illness and its outcome.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.