Back
Pregnancy-related acute kidney injury (PRAKI) is a major cause of maternal and fetal morbidity and mortality, hemodialysis requirement in low and middle income countries.
With improvement in antenatal and postnatal care, the incidence of PRAKI in India has steadily declined from 22% in 1960s to 9%in 1980s, and further down to 3–7% in 2000s, because of improvements in reproductive health care.
Preeclampsia affects 3-5% of all pregnancies, a major source of maternal, fetal and neonatal morbidity and mortatlity world wide.
Hypertensive disorders of pregnancy are at increased risk of AKI, PRAKI in the setting of HELLP syndrome Preeclampsia has been associated with increased risk of placental abruption and pulmonary edema.
Aim :
To study the profile and outcomes of preeclampisa patients with AKI
Study Design :
Observational study
Study Setting :
Tertiary Care Teaching Hospital, Hyderabad, Telangana,India.
subjects:
All pregnant patients of preeclampsia with AKI admitted at our hospital
Period of study :
Jan 2014 to Oct 2023
Methodology :
This is an observational study done in the Tertiary care Government hospital in Telangana.
Data collected prospectively from All preeclampsia patients who developed AKI.
preeclampsia is diagnosed as per ACOG guidelines
AKI staging was based on KDIGO guidelines.
Data regarding demographic profile, maternal and fetal outcomes were assessed.
Patients were supported with Renal Replacement Therapy in the form of Bedside Hemodialysis, as per indications (oliguria, anuria, no response to fluid challenge, acidosis, severe renal failure).Hemodialysis was given with 1.2 m2 surface area dialyzers, heparin free, single usedialyzers.
Hemodynamically unstable patients were provided with Peritoneal dialysis services (if the patient was delivered by Normal vaginal delivery, after one week post LSCS) & CRRT(severe sepsis with hemodynamic instability, MOSF) and Hemodialysis was started after stabilisation
Results :
A total of 221 patients satisfied inclusion criteria.
Demographic profile
No of patients
percentage
Age
25.01+/-4.9
Conclusion:
The Incidence of pregnancy related Acute Kidney Injury in context of all cases of AKI was 4.24%
Preeclampsia constitutes 44.9% of cases of PRAKI
Incidence IUD was high in preeclampsia group 66.55% Vs non-preeclampsia group 36.5%.
Renal Replacement was required in 59.55%
Factors affecting mortality are MOSF, hemodynamic instability on admission, Severe renal insufficiency.
Limitations of the study:
Lack of longterm Follow-up.