A Single-Centre Experience of Obstetric Acute Kidney Injury.

BACKGROUND: Acute kidney injury (AKI) is a clinical syndrome characterized by a sudden decline in glomerular filtration rate leading to decreased excretion of nitrogenous waste products. It continues to be a common problem in developing countries.

AIMS: The aim of this study was to understand AKI characteristics in pregnancy and identify the factors related to its unfavorable outcome.

STUDY DESIGN: A prospective cross-sectional study.

METHODS: This prospective study was conducted between January 2013 and May 2014. In total 570 women with AKI were referred to the Kidney Institute during this period, out of which 52 patients with obstetrics AKI were included in this study.

RESULTS: Incidence of obstetric AKI was 9.12 %. Their age varied from 19 to 34 years, with an average of 26.2 years. About 42(80.8 %) patients had not received antenatal care. The main causes of AKI were obstetric hemorrhage (38.46 %) and puerperal sepsis (15.38 %). The outcome was favorable with complete renal function recovery in 55.76 % patients. Four (7.69 %) patients became dialysis dependent. Maternal mortality was 32.69 %.

CONCLUSION: Obstetric AKI is a critical situation in developing countries. Lack of antenatal care (80.8 %) is a major contributing factor for obstetric-related complications leading to renal failure. Obstetric hemorrhage (38.46 %) is the most common cause of obstetric AKI. Late referral in 18 (34.61 %), puerperal sepsis in six (33.33 %), obstetric hemorrhage in five (27.77 %) and combined sepsis and hemorrhage in five (27.77 %) are the common contributing factors leading to its unfavorable outcomes as maternal morbidity and mortality. Hence, a multidisciplinary approach is warranted to prevent such an avoidable complication.