Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, Mbarara, Uganda.
BMC Nephrol. 2022 Nov 2;23(1):353. doi: 10.1186/s12882-022-02972-8.
The presence of acute kidney injury (AKI) in pre-eclampsia complicates treatment including; increasing length of hospital stay and a need to access services like dialysis which are largely expensive in resource-limited settings. We aimed to determine incidence and predictors of acute kidney injury among women with severe pre-eclampsia at Mbarara Regional Referral Hospital in southwestern Uganda.
We carried out a hospital-based prospective cohort study from 16 November 2018 to 18 April 2019, among pregnant women with severe pre-eclampsia followed up in the hospital. We enrolled 70 mothers with severe pre-eclampsia and eclampsia; we excluded patients with a history of chronic kidney disease, chronic hypertension, and gestational hypertension. Data on socio-demographics, laboratory parameters, health system, obstetric and medical factors were collected. Baseline serum creatinine, complete blood count, and CD4 T-cell count were all done at admission (0-hour). A second serum creatinine was done at 48-hours to determine the presence of AKI and AKI was defined as a relative change of serum creatinine value at least 1.5 times the baseline (i.e., at admission) within 48 h. The proportion of women diagnosed with acute kidney injury among the total number of women with severe pre-eclampsia was reported as incidence proportion. Univariate and multivariate logistic regression was used to establish the association between acute kidney injury and severe pre-eclampsia.
Incidence of acute kidney injury was high (42.86%) among women with severe pre-eclampsia. Antenatal care attendance was protective with an odds ratio of 0.14 (0.03, 0.73), p-value 0.020 at bivariate analysis but had no statistical significance at multivariate analysis. Eclampsia was an independent risk factor for acute kidney injury. (aOR 5.89 (1.51, 38.88), p-value 0.014.
The incidence of acute kidney injury in patients with severe pre-eclampsia is high. Eclampsia is an independent risk factor of acute kidney injury. The findings of this study highlight the urgent need for more research and better perinatal care for these women.
子痫前期合并急性肾损伤（AKI）会使治疗变得复杂，包括延长住院时间和需要透析等服务，而在资源有限的情况下，这些服务往往费用高昂。我们旨在确定乌干达西南部姆巴拉拉地区转诊医院严重子痫前期患者中 AKI 的发生率和预测因素。
我们于 2018 年 11 月 16 日至 2019 年 4 月 18 日进行了一项基于医院的前瞻性队列研究，研究对象为在医院接受随访的严重子痫前期孕妇。我们纳入了 70 名患有严重子痫前期和子痫的母亲；排除了患有慢性肾脏病、慢性高血压和妊娠期高血压病史的患者。收集了社会人口统计学、实验室参数、卫生系统、产科和医疗因素的数据。所有患者均在入院时（0 小时）进行基础血清肌酐、全血细胞计数和 CD4 T 细胞计数。在 48 小时时进行第二次血清肌酐检查，以确定 AKI 的存在，并将 48 小时内血清肌酐值至少增加 1.5 倍（即在入院时）定义为 AKI。严重子痫前期患者中诊断为急性肾损伤的女性比例报告为发生率比例。采用单变量和多变量逻辑回归分析来确定急性肾损伤与严重子痫前期之间的关系。
严重子痫前期患者中急性肾损伤的发生率较高（42.86%）。产前护理的参与具有保护作用，优势比为 0.14（0.03，0.73），p 值为 0.020（在单变量分析中），但在多变量分析中无统计学意义。子痫是急性肾损伤的独立危险因素。（aOR 5.89（1.51，38.88），p 值为 0.014）。
严重子痫前期患者中急性肾损伤的发生率较高。子痫是急性肾损伤的独立危险因素。本研究的结果强调了迫切需要对这些妇女进行更多的研究和更好的围产期护理。
