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Pregnancy-related acute kidney injury (PRAKI) may comprise up to 25% of the referrals to dialysis centers in developing countries and is associated with substantial maternal and fetal mortality. All factors that can cause AKI in a non-pregnant woman can theoretically cause renal failure in a pregnant woman, including volume depletion, bleeding and sepsis. This study was done to evaluate the contributing factors responsible for pregnancy-related AKI, to assess the frequency of cortical necrosis and acute tubular necrosis and factors contributing to their development.
The study was carried out in the premises of a tertiary care center located in a major city in south India. The target population for the present study included 70 pregnant patients who developed AKI during the course of their pregnancy as defined by KDIGO criteria for AKI. The study was conducted over one year from October 2022 to September 2023. Detailed history, clinical examination and investigations were performed in all patients. Renal biopsy was performed if a patient was oliguric or required dialysis at the end of three weeks.Hemodialysis or peritoneal dialysis was performed according to standard indications. Statistical analysis was performed with unpaired t test. P < 0.05 was accepted as the level of statistical significance.
The mean age of patients with pregnancy-related AKI(PRAKI) was 25.6 years. Twenty-five patients (35.71%) presented with anuria, while 44 (62.85%) with oliguria and one patient had non-oliguric renal failure. In 61.42% of the patients, puerperal sepsis was the most common etiological factor leading to AKI, while 32.85% of the patients had DIC on presentation. Hemorrhage as the etiology for AKI was present in 38.56% of the patients, APH in 14.28% and PPH in 24.28% of patients. Preeclampsia, eclampsia and HELLP syndrome accounted for 28.57% of patients with PRAKI. Sepsis post abortion as a precipitating event for AKI was present in 20% of the patients. A majority of the patients (97.14%) underwent hemodialysis. Peritoneal dialysis was initially performed in 8 patients (11.42%) due to initial hypotension, 7 patients among which improved and received hemodialysis later. Of the 81.42% surviving patients who were discharged, 54.28% had complete recovery of renal function, 12.85% had partial recovery and 14.28% required chronic dialysis. In the present study, renal biopsy was performed in 11 patients of which 10 had cortical necrosis and 1 had glomerular endotheliosis associated with preeclampsia. Factors affecting patient survival were sepsis, thrombocytopenia, DIC and liver involvement (P < 0.05), whereas the duration of dialysis and anuria on presentation were associated with poor renal outcome (P < 0.05).
Pregnancy-related AKI is a common occurrence with puerperal sepsis being the most common etiological factor. AKI due to post-abortal sepsis is still a common complication which can contribute to a high incidence of biopsy-proven renal cortical necrosis. Sepsis, thrombocytopenia, DIC and liver involvement were associated with maternal mortality. The outcome of this study emphasizes the need for strict aseptic precautions in developing countries to minimize the maternal mortality due to sepsis.