A Prospective Analysis of Feto - Maternal Outcomes in Pregnancy Related Acute Kidney Injury

Background: The incidence of pregnancy related acute kidney injury in pregnancy (PRAKI) has declined significantly over the last three decades in developing countries. However, it is still associated with significant feto - maternal morbidity and mortality. The risk factors associated with advanced maternal age such as hypertension, diabetes, chronic kidney disease, and those associated with reproductive technologies such as multiple gestations are increasing. Traditional causes of PRAKI, such as septic abortions and puerperal sepsis, have been replaced by hypertensive diseases, such as preeclampsia and thromboticmicroangiopathies comprising thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS). Aim: Our study aimed at analyzing the etiological factors, clinical presentation and feto - maternal outcomes of patients with pregnancy related acute kidney injury. Material and Methods: A prospective observational study of patients with obstetric complication and pregnancy related medical conditions leading to acute kidney injury was conducted for a period of one year. Factors? contributing to acute kidney injury during pregnancy and puerperium and their feto maternal outcome was studied. Results: Out of 12953 obstetric admissions and 9099 deliveries in one year, the incidence of PRAKI was 3.3%. Severe preeclampsia was the major contributing factor for PRAKI with 38%. 58% of the patients were multigravida.72%developed AKI in third trimester and puerperium. HUS and sepsis were associated with higher mortality. Incidence of mortality is 33% among pregnancy complicated with AKI. This accounted to about 18% of total maternal deaths in our institution.66 % of patients recovered with no prolonged morbidity.9% of the pregnancies with AKI progressed to ESRD. Our study reported 29% perinatal mortality in the pregnancies with AKI. The implementation of specific interventions for the prevention, diagnosis and management of AKI in pregnant women may reduce the maternal and fetal morbidity and mortality.