Yadav Sushma, Chauhan Meenakshi, Jain Deepak, Aggarwal H K, Yadav R K
Department of Obstetrics and Gynaecology, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana, India.
Department of Department of Obstetrics and Gynaecology, PGIMS, Rohtak, India.
Maedica (Bucur). 2022 Mar;17(1):80-87. doi: 10.26574/maedica.2022.17.1.80.
This study aimed to investigate the incidence, clinical characteristics, and outcomes of acute kidney injury (AKI) during pregnancy in Indian population. A prospective observational study was conducted in pregnant patients admitted to Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India. Acute kidney injury was assessed using Risk, Injury, Failure, Loss of function, and End-stage renal disease (RIFLE) criteria. Patients were analyzed on the basis of demographic data, detailed history, clinical examination, and laboratory investigations. The primary outcome was maternal renal outcome, including return to normal renal function and progression to chronic kidney disease (CKD). The secondary outcomes included the mode of delivery, complications of pregnancy, intensive care unit (ICU) admission, and maternal death. A total of 51 patients with an average age of 29.5 years were included in the present study. About 49.9% of subjects had severe anemia and 41.2% were primigravida. The main cause of AKI was pre-eclampsia and postpartum hemorrhage. There was a marked improvement in renal outcome with 33 patients having complete renal recovery and six patients developed CKD was observed during three months follow-up period. The peaked median value of blood urea was 62.0 mg% in patients with normal renal function, 178.5 mg% in those with CKD and 120.0 mg% in expired patients (P=0.001). A statistically significant change in serum potassium (P=0.010) and creatinine levels (P<0.001) was observed during the follow-up period. Liver enzymes, including serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase, were high in all patients at the time of admission, but decreased to normal on follow-up. Our study indicates that pregnancy-related AKI patients present with multiorgan complications and many of them require mechanical ventilation and renal replacement therapy. Most of these patients have poor outcome. Hence, the management of pregnancy-related AKI presents a challenge that requires proper evaluation of causative factors to facilitate appropriate treatment.
本研究旨在调查印度人群妊娠期急性肾损伤（AKI）的发病率、临床特征及预后。在印度哈里亚纳邦罗塔克市的Pt. B.D. Sharma研究生医学教育与研究学院收治的孕妇中开展了一项前瞻性观察性研究。采用风险、损伤、衰竭、肾功能丧失和终末期肾病（RIFLE）标准评估急性肾损伤。根据人口统计学数据、详细病史、临床检查和实验室检查对患者进行分析。主要结局为孕产妇肾脏结局，包括肾功能恢复正常和进展为慢性肾脏病（CKD）。次要结局包括分娩方式、妊娠并发症、重症监护病房（ICU）收治情况及孕产妇死亡。本研究共纳入51例平均年龄为29.5岁的患者。约49.9%的受试者患有严重贫血，41.2%为初产妇。AKI的主要病因是子痫前期和产后出血。在三个月的随访期内，观察到肾脏结局有显著改善，33例患者肾功能完全恢复，6例患者发展为CKD。肾功能正常患者的血尿素峰值中位数为62.0 mg%，CKD患者为178.5 mg%，死亡患者为120.0 mg%（P = 0.001）。随访期间血清钾（P = 0.010）和肌酐水平（P < 0.001）有统计学显著变化。入院时所有患者的肝酶，包括血清谷草转氨酶和血清谷丙转氨酶均升高，但随访时降至正常。我们的研究表明，妊娠期AKI患者存在多器官并发症，其中许多患者需要机械通气和肾脏替代治疗。这些患者大多预后不良。因此，妊娠期AKI的管理面临挑战，需要对病因进行恰当评估以促进合理治疗。
