Professor and Head;Corresponding Author.
Postgraduate.
J Assoc Physicians India. 2022 Aug;70(8):11-12. doi: 10.5005/japi-11001-0064.
Pregnancy-related acute kidney injury (PRAKI) is a common problem in the developing world.
In this retrospective observational study at a tertiary care hospital in South India we evaluated records for the maternal, fetal, and renal outcomes in women with PRAKI.
Over a 10-year period, 395 patients of PRAKI were seen constituting 8.1% of all acute kidney injury (AKI). The mean age of patients was 27 ± 3 years. A total of 176 (44.5%) had pre-eclampsia, 132 (33.4%) had puerperal sepsis, 76 (19.2%) had antepartum hemorrhage or postpartum hemorrhage (APH 30/PPH 46), nine (2.2%) had hemolytic uremic syndrome (HUS). Obstruction was seen in two patients. Eleven had underlying glomerulonephritis out of three had lupus nephritis. Forty-five of 395 (11.39%) had hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, that is, 25.5% of those with pre-eclampsia. Sixteen (4.0%) had placental abruption. A total of 288 (72.9%) presented postpartum. Renal biopsy done in 103 (26%) showed patchy cortical necrosis (PCN) in 25 (22.3%), diffuse cortical necrosis (DCN) in 23 (20.3%), acute tubular necrosis (ATN) in 20 (19.4%), acute interstitial nephritis (AIN) in 10 (9.7%), while nine (8.7%) had thrombotic microangiopathy (TMA). Glomerular disease was seen in 11. Cortical necrosis (CN) was seen in 48 patients of which 10 (20.83%) had abruption placenta, 25 (52%) had puerperal sepsis, 11 (22.9%) had postpartum hemorrhage (PPH), and two (4.1%) had TMA. A total of 290 (73.4%) required dialysis. About 76% improved while 8.3% progressed to end-stage renal disease (ESRD). Maternal mortality (MM) was 5%. There were 42 intrauterine deaths and 30 deaths in the neonatal period.
Pregnancy-related acute kidney injury in developing countries is more common as compared to the West. Only 49% patients had booked pregnancy, that is, received regular antenatal care. Apart from pre-eclampsia which is also the major cause in the West and was the etiology in 44% of patients with PRAKI in our study, sepsis (33%) and maternal hemorrhage (19%) were also significant. Immediate recovery from PRAKI was 75% however about 8% develop end-stage kidney disease (ESKD) while in the west ESKD occurred in only about 2%.
Pregnancy-related acute kidney injury is an important cause of maternal and fetal morbidity and mortality. Pre-eclampsia emerged as the most common cause of PRAKI and CN was the most common histological lesion. Proper antenatal care and management may improve pregnancy outcomes.
妊娠相关急性肾损伤（PRAKI）是发展中国家的一个常见问题。
在印度南部一家三级保健医院进行的这项回顾性观察性研究中，我们评估了患有 PRAKI 的女性的母婴和肾脏结局的记录。
在 10 年期间，共有 395 例 PRAKI 患者，占所有急性肾损伤（AKI）的 8.1%。患者的平均年龄为 27 ± 3 岁。共有 176 例（44.5%）患有子痫前期，132 例（33.4%）患有产褥期败血症，76 例（19.2%）有产前或产后出血（APH 30/PPH 46），9 例（2.2%）患有溶血尿毒综合征（HUS）。有 2 例患者存在梗阻。有 3 例患者存在自身免疫性肾小球肾炎，其中 11 例患者存在血小板减少症。在 395 例患者中，有 45 例（11.39%）存在溶血性贫血、肝酶升高和血小板减少（HELLP）综合征，即子痫前期患者中的 25.5%。有 16 例（4.0%）发生胎盘早剥。共有 288 例（72.9%）在产后就诊。对 103 例患者进行了肾脏活检，结果显示 25 例（22.3%）存在斑片状皮质坏死（PCN），23 例（20.3%）存在弥漫性皮质坏死（DCN），20 例（19.4%）存在急性肾小管坏死（ATN），10 例（9.7%）存在急性间质性肾炎（AIN），9 例（8.7%）存在血栓性微血管病（TMA）。有 11 例存在肾小球疾病。有 48 例患者存在皮质坏死（CN），其中 10 例（20.83%）发生胎盘早剥，25 例（52%）发生产褥期败血症，11 例（22.9%）发生产后出血（PPH），2 例（4.1%）发生 TMA。共有 290 例（73.4%）需要透析。约 76%的患者有所改善，而 8.3%的患者进展为终末期肾病（ESRD）。产妇死亡率（MM）为 5%。有 42 例宫内胎儿死亡，30 例新生儿死亡。
与西方国家相比，发展中国家妊娠相关急性肾损伤更为常见。只有 49%的患者有预约妊娠，即定期接受产前护理。除了子痫前期也是西方国家的主要病因，也是我们研究中 44%的 PRAKI 患者的病因外，败血症（33%）和产妇出血（19%）也是重要的病因。PRAKI 的即刻恢复率为 75%，但约 8%的患者发展为终末期肾病（ESKD），而在西方国家，ESKD 仅发生在约 2%的患者中。
妊娠相关急性肾损伤是母婴发病率和死亡率的重要原因。子痫前期是 PRAKI 最常见的病因，CN 是最常见的组织学病变。适当的产前护理和管理可能会改善妊娠结局。
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