Mir M M, Najar M S, Chaudary A M, Azad H, Reshi A R, Banday K A, Bhat M A, Wani I A, Wani M M, Ursilla M
Department of Nephrology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Indian J Nephrol. 2017 May-Jun;27(3):181-184. doi: 10.4103/0971-4065.194391.
Pregnancy-related-acute kidney injury (PR-AKI) had decreased from 40% to 20% in 1960 to <10% in recent series, mostly due to meticulous antenatal management. Postpartum-AKI (PP-AKI) resulting from late obstetric complications has become more apparent after improvement in antenatal care and legalization of medical termination of pregnancy. Women with renal injury in peripartum period admitted to our hospital over a period of 2 years (April 2013 to May 2015) were studied. Of 713 patients of AKI admitted, 61 had PR-AKI with an incidence of 4.27%. Out of the 61 patients, 28 had PP-AKI with an incidence of 1.96%. The mean age of patients with PP-AKI was 26.10 ± 4.3 years. Sepsis was the most common cause accounting for 11 (39.28%) cases followed by postpartum hemorrhage (PPH) in 7 (25%) cases. Renal biopsy was done in nine patients, out of whom four were having cortical necrosis. Patients having diffuse cortical necrosis remained dialysis-dependent. High contribution of sepsis and PPH to PP-AKI in our setting makes it an ideal target for rectification. Protocolized peripartum monitoring and standard clinical practices of asepsis will go long way in decreasing the incidence of PP-AKI and maternal morbidity in our valley.
妊娠相关急性肾损伤（PR-AKI）在1960年时从40%降至20%，在近期系列研究中则降至<10%，这主要归功于细致的产前管理。在产前护理得到改善以及人工流产合法化之后，由晚期产科并发症导致的产后急性肾损伤（PP-AKI）变得更加明显。我们对在两年期间（2013年4月至2015年5月）收治于我院的围产期肾损伤女性进行了研究。在713例急性肾损伤患者中，61例患有PR-AKI，发病率为4.27%。在这61例患者中，28例患有PP-AKI，发病率为1.96%。PP-AKI患者的平均年龄为26.10±4.3岁。脓毒症是最常见的病因，占11例（39.28%），其次是产后出血（PPH），占7例（25%）。对9例患者进行了肾活检，其中4例存在皮质坏死。患有弥漫性皮质坏死的患者仍依赖透析。在我们的研究环境中，脓毒症和PPH对PP-AKI的高贡献率使其成为纠正的理想目标。规范化的围产期监测和无菌操作规范的临床实践对于降低我们所在地区PP-AKI的发病率和孕产妇发病率将大有帮助。
