Introduction:
Acute kidney injury (AKI) represents one of the serious complications of severe pre-eclampsia and may require urgent hemodialysis. The aim of our study was to specify the clinical, biological, therapeutical, evolutionary characteristics and predictive factors of the use of hemodialysis during AKI complicating severe pre-eclampsia.
Methods:
We conducted a retrospective study over a 15-year period (March 2008 - December 2023). Parturients with AKI during the third trimester of pregnancy or during the first week after delivery following pre-eclampsia were included. AKI in the first trimester and patients with previous nephropathy were excluded. Severe AKI was defined by stage 3 of the “KDIGO2012” classification.
Results:
41 patients were collected during the study period. The average age was 30 ± 6.1 years (17 to 42 years). The average gestational age was 32.2 ± 2.2 weeks of amenorrhea.38 % of parturients were multiparous. For the delivery types : A non-medicalized home delivery was noted in 4.9%, vaginal delivery in 21.5%, cesarean section in 63.4%. The main clinical manifestations were: high blood pressure in 90.2% of cases and oligoanuria in 80.5% of cases. Hemodialysis was necessary in 29 patients (70.7%). Fetal mortality was observed in 46% cases and maternal mortality in 24.4%. Recovery of renal function observed in 83.8% of cases. Two cases of cortical necrosis observed in our serie.
Predictive factors for the use of hemodialysis were initial admission to the intensive care unit (p = 0.005), oligoanuria (p = 0.01), HELLP syndrome (p = 0.003), and retro-placental hematoma (p = 0.04).
Conclusions:
AKI in the obstetric context is a relatively frequent complication but grafted with a heavy maternal and fetal mortality. The improvement of the health infrastructure, the optimization of human resources and the mandatory establishment of monitoring of high-risk pregnancies are necessary means to prevent the occurrence of obstetric complications.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.