Department of Medicine, University of Cape Town, Cape Town, South Africa; Division of Hypertension and Nephrology, Groote Schuur Hospital, Cape Town, South Africa.
Department of Nephrology, Seth G.S.M.C. & K.E.M. Hospital, Mumbai, India.
Semin Nephrol. 2022 Sep;42(5):151317. doi: 10.1016/j.semnephrol.2023.151317. Epub 2023 Apr 1.
Despite immense global effort, the maternal mortality rate in low-resource settings remains unacceptably high. Globally, this reflects the grave inequalities in access to health and reproductive services. Pregnancy-associated acute kidney injury (PRAKI) is an independent risk factor for mortality. The reported incidence of PRAKI in low- and middle-income countries is higher than that of high-income countries (4%-26% versus 1%-2.8%, respectively). Hypertensive disorders are now the leading cause of PRAKI in many regions, followed by hemorrhage and sepsis. PRAKI in low-resource settings carries a high mortality for both mother and child. Outcome studies suggest that PRAKI is associated with residual kidney dysfunction and may lead to dialysis dependence. This can be a death sentence in many regions with limited kidney replacement therapy. This review will summarize data on PRAKI on the African, Latin American, and Asian continents over the past decade. It will include the progress in published data, mortality, and treatment interventions and provide recommendations for the next decade.
尽管全球付出了巨大努力,但资源匮乏地区的孕产妇死亡率仍然高得令人无法接受。这反映了全球范围内在获得卫生和生殖服务方面存在严重不平等。妊娠相关性急性肾损伤(PRAKI)是死亡的独立危险因素。据报道,低中收入国家的 PRAKI 发病率高于高收入国家(分别为 4%-26%和 1%-2.8%)。在许多地区,高血压疾病现在是 PRAKI 的主要原因,其次是出血和败血症。资源匮乏地区的 PRAKI 对母婴死亡率都很高。预后研究表明,PRAKI 与肾脏残留功能障碍有关,并可能导致透析依赖。在许多肾脏替代治疗有限的地区,这可能是死刑判决。这篇综述将总结过去十年非洲、拉丁美洲和亚洲大陆 PRAKI 的相关数据。它将包括已发表数据、死亡率和治疗干预方面的进展,并为下一个十年提供建议。