印度北部人群中妊娠相关急性肾损伤的母婴结局
Feto-maternal outcome of pregnancy related acute kidney injury in a North Indian population.
作者信息
Sachan Rekha, Shukla Savita, Shyam Radhey, Sachan Pushp L, Patel Munna L
机构信息
Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, India.
Department of Geriatric Mental Health, King George Medical University, Lucknow, India.
出版信息
J Family Community Med. 2022 Sep-Dec;29(3):204-211. doi: 10.4103/jfcm.jfcm_117_22. Epub 2022 Sep 7.
BACKGROUND
Acute kidney injury (AKI) is a serious complication in pregnancy, resulting in significant maternal and fetal morbidity/mortality. The aim of this study was to evaluate the magnitude of pregnancy-related AKI (PRAKI) in a North Indian population, and its contributing factors.
MATERIALS AND METHODS
This prospective study was carried out at the department of obstetrics and gynecology in collaboration with the nephrology unit and internal medicine department at King George Medical University from June 2019 to October 2020. After informed consent and ethical clearance, a total of 150 PRAKI women were enrolled, and 98 women were subjected to renal replacement therapy as per Kidney Disease Improving Global Outcomes 2012 guideline and were followed for 3 months for renal and fetomaternal outcome.
RESULTS
There was a high incidence (1.02%) of AKI during pregnancy and puerperium. Majority (57.3%) of the women were aged 26-30 years, and 93.3% had institutional deliveries. About 49% of the women suffering from PRAKI were multipara, and most were identified in the postpartum period (82%). Hypertensive disorder of pregnancy (48%), puerperal sepsis (45%), and hemorrhage (34%) were the associated causes for PRAKI. Stillbirth/intrauterine death (IUD) was higher in Stage II (53.8%) and Stage III AKI (37.7%) (none in Stage I AKI). The majority of the neonates were born with a birth weight of ≤2500 g irrespective of the stages of AKI. Preterm deliveries were significantly higher in Stage II AKI (53.8%) than in Stage I (33.3%) and Stage III (20.0%). Thirty-seven cases of PRAKI were managed conservatively, while 98 required dialysis. Complete recovery occurred in 27.3% and partial renal recovery in 31.3%. However, 3.3% progressed to chronic kidney disease, 34% expired, and 4% were lost to follow-up. High maternal mortality of 30.1% was observed in those dialyzed.
CONCLUSION
AKI is associated with fetal growth restriction and preterm deliveries. Stillbirth/IUD is higher in Stage II and Stage III AKI.
背景
急性肾损伤（AKI）是妊娠期一种严重的并发症，会导致显著的母婴发病率/死亡率。本研究的目的是评估印度北部人群中与妊娠相关的急性肾损伤（PRAKI）的严重程度及其相关因素。
材料与方法
本前瞻性研究于2019年6月至2020年10月在乔治国王医科大学妇产科与肾病科及内科合作开展。在获得知情同意并通过伦理审查后，共纳入150例PRAKI女性患者，其中98例患者根据2012年改善全球肾脏病预后组织（KDIGO）指南接受了肾脏替代治疗，并随访3个月以观察肾脏及母婴结局。
结果
妊娠和产褥期AKI的发病率较高（1.02%）。大多数（57.3%）女性年龄在26 - 30岁之间，93.3%在医疗机构分娩。患有PRAKI的女性中约49%为经产妇，且大多数在产后阶段被确诊（82%）。妊娠高血压疾病（48%）、产褥期败血症（45%）和出血（34%）是PRAKI的相关病因。死产/宫内死亡（IUD）在Ⅱ期AKI中较高（53.8%），在Ⅲ期AKI中为37.7%（Ⅰ期AKI中无）。无论AKI处于何阶段，大多数新生儿出生体重≤2500g。Ⅱ期AKI的早产率（53.8%）显著高于Ⅰ期（33.3%）和Ⅲ期（20.0%）。37例PRAKI患者接受了保守治疗，98例需要透析。27.3%实现了完全康复，31.3%实现了部分肾脏恢复。然而，3.3%进展为慢性肾脏病，34%死亡，4%失访。接受透析的患者中观察到较高的孕产妇死亡率，为30.1%。
结论
AKI与胎儿生长受限和早产相关。Ⅱ期和Ⅲ期AKI中的死产/IUD发生率较高。
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