SPECTRUM OF PREGNANCY RELATED ACUTE KIDNEY INJURY IN SOUTH ASIA: A SINGLE CENTER STUDY FROM BANGLADESH

 

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SPECTRUM OF PREGNANCY RELATED ACUTE KIDNEY INJURY IN SOUTH ASIA: A SINGLE CENTER STUDY FROM BANGLADESH

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Sheikh Imran
Hossen
Sheikh Imran Hossen dr.s.imran.nephrology@gmail.com Mugda medical college hospital Nephrology Dhaka Bangladesh *
Jyoti Vaskar Saha jyovas@gmail.com Mugda medical college hospital Nephrology Dhaka Bangladesh -
Muhammad Saiful Ahsan Rana saifulahsan@gmail.com Mugda medical college hospital Nephrology Dhaka Bangladesh -
Gul Jannat dr.guljannat@gmail.com Mugda medical college hospital Nephrology Dhaka Bangladesh -
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Although Pregnancy-related acute kidney injury (PRAKI) decreased in the developed countries but still a common occurrence in developing countries. It is a serious complication in pregnancy and delay in the diagnosis and late referral is associated with significant maternal morbidity and mortality and fetal loss. This study aimed to investigate the time of occurrence of AKI ,etiology ,histology and maternal outcome of AKI in pregnancy.

A prospective observational study was conducted in pregnant women and within 6weeks of postpartum patients  admitted with AKI in the  department of nephrology in a tertiary care hospital of Bangladesh between January 2024 and December 2024  . Acute kidney injury was assessed using  Kidney Disease: Improving Global Outcomes guidelines. Patients with a previous diagnosis of CKD, evidenced by elevated serum creatinine levels before pregnancy or by ultrasound findings of small-sized kidneys were excluded. All patients were analyzed on the basis of demographic data, detailed medical history and clinical examination related to the pregnancy and postpartum period including gestational age, mode of delivery, history of pregnancy-induced hypertension, postpartum hemorrhage and laboratory investigations  and followed up for the next six months. Kidney biopsy was considered if there was no significant recovery in renal function by the end of 3 weeks of supportive treatment. The primary outcome of the study was to establishing etiology and histological diagnosis of PRAKI.  The secondary outcomes include timing of AKI,  identify the proportion of patients who progress to CKD or end-stage kidney disease at 3 months, rate of recovery and motility from AKI. Complete recovery was defined as a reduction in serum creatinine to ≤ 1.2 mg/dl, and dialysis dependency was recorded if the patient continues to require dialysis at discharge and during follow-up for 3 months.

Total 136 patients were included and mean age was 23.4 ± 5.73 years. Most of the AKI was noted in postpartum period (65%). Etiology of AKI was sepsis (43%), pre-eclampsia and eclampsia (16%), postpartum hemorrhage (14%), acute gastroenteritis (10%), thrombotic microangiopathy (TMA) (9%) and glomerular diseases (8%).  Renal biopsy was done in  56 of these patients and  showed renal cortical necrosis (34%), acute tubular injury (26%), glomerular disease (16%) ,TMA(15%) and acute tubulointerstitial disease (9%).  Thirty-four patients were managed conservatively, while 102 required dialysis. 49% patient had complete recovery ,20 % had partial recovery at 3 months and 25 % progressed to ESRD and mortality rate was 5.8%.The cause of death was septicemia in four, pre-eclampsia in three and  PPH in one patient.

Pregnancy-related AKI was common in postpartum period and  sepsis, a largely preventable entity, was the major cause of AKI despite increase in the number of institutional deliveries and is associated with poor outcome and cortical necrosis is the most common histological findings. Increasing awareness programs on prevention of sepsis in peripheral health-care facilities may help to reduce burden of PRAKI.

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