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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Acute kidney injury (AKI) during pregnancy and the postpartum period is a significant cause of maternal morbidity, mortality, and fetal loss, particularly in developing countries. Pregnancy-related acute kidney injury (PRAKI) remains prevalent. This study aims to analyze renal biopsies in PRAKI to determine the etiology, guide management, and predict outcomes.
A retrospective review of 302 native renal biopsies from patients with PRAKI at a tertiary care center in India between January 2014 and October 2024 was conducted. Histopathological (renal biopsy) slides were analyzed. Biopsy was done in PRAKI with non- recovery with in 10days or those with active sediment. Clinical data, laboratory findings, were collected. Patient outcomes were tracked for one year after hospital admission to assess recovery.
Inclusion criteria: patients with AKI during pregnancy and the peripartum period who were in the selected study hospital from January 2014 to October 2025.and who were non recover AKI underwent renal biopsy procedure.
Exclusion criteria: patients who were recover from AKI within 10 days and no need of renal biopsy, patients with pre-existing kidney disease were excluded from the study.
The mean age of the 302 patients was 26.5 ± 4.6 years. Surgical interventions included cesarean sections in 61%, vaginal deliveries in 23.2%, and obstetric hysterectomies in 1.2%. Spontaneous termination occurred in 12.8%. The leading causes of AKI were sepsis (40.6%), hemorrhage (24.5%), preeclampsia (11%), and others (23%). Fetal loss occurred in 20.08%.Renal biopsy revealed patchy cortical necrosis (36%), diffuse cortical necrosis (23%), acute tubular necrosis (19%), acute interstitial nephritis (15%), thrombotic microangiopathy (3%), IgA nephropathy (3%), and lupus nephritis (1%).Hemodialysis was required in 97%, and plasmapheresis in 2.8%. In-hospital mortality was 7.2%, predominantly due to sepsis with shock. At 1-year follow-up, 45.02% achieved complete recovery, 21.21% had partial recovery, and 36.36% required ongoing renal replacement therapy. Two patients underwent successful live-related renal transplantation. Biopsy–outcome correlation revealed the best prognosis in acute tubular necrosis (83.3% recovery) and acute interstitial nephritis (78.9%), while diffuse cortical necrosis (79.3% RRT) and TMA (71.4% RRT) were associated with poor outcomes.
PRAKI is a critical complication in pregnancy, with sepsis being the most common cause, followed by hemorrhage and preeclampsia. Renal biopsy helps identify the underlying pathology and guide treatment, particularly in non-recovery cases. Ours is one of the largest studies on PRAKI patients with documented renal histology. Acute cortical necrosis was the most frequent finding followed by acute tubular necrosis. High incidence of cortical necrosis may be explained by most severe patients getting admitted to our hospital as it is a tertiary referral care center for numerous obstetric centers. Also mostly biopsies are done is severe cases where there is non- recovery of renal functions. Biopsy helps in diagnosis of TMA and other glomerular and interstitial diseases which guides treatment. Early diagnosis and prompt treatment are essential for improving maternal and fetal outcomes in PRAKI.
