Orhewere Ejiro Praise, Okoye Ogochukwu Chinedum, Adejumo Oluseyi Ademola
Department of Internal Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria.
Department of Internal Medicine, Delta State University, Abraka, Delta State, Nigeria.
Niger Med J. 2023 Dec 28;64(5):627-636. doi: 10.60787/NMJ-64-5-361. eCollection 2023 Sep-Oct.
Pregnancy-related acute kidney injury (PRAKI) is a common cause of AKI globally. The incidence and burden of PRAKI are still high in low and middle-income countries (LMICs) especially in Africa due to limited access to optimal obstetric care, late diagnosis, and referral. The study aimed to determine the incidence and aetiologies of PRAKI among women in the peripartum period in two government hospitals in Nigeria.
This was a prospective study where serum creatinine was measured among pregnant women presenting in labour at 0-hour, 6 hour, 12 hour, 24 hour, 48 hour and 7 days post-delivery. AKI was defined using the Kidney Disease Improving Global Outcome criteria. Binary logistic regression was used to determine predictors of PRAKI.
The mean age of the 162 pregnant women who completed the study was 30.05±1.28 years. The incidence of AKI use was 22.2%. The aetiologies of PRAKI were obstetric haemorrhage (66.7%), eclampsia (19.4%), and sepsis (13.9%). Seventeen (47.2%) patients had Stage 1 PRAKI, 12 (33.3%) had Stage 2 PRAKI, while seven (19.4%) had Stage 3 PRAKI. Factors significantly associated with PRAKI were parity (p=<0.001), caesarean section (p=<0.001), excess blood loss (p=<0.001), and prolonged duration of labour (p=0.002).
PRAKI occurred in 1 out 5 pregnant women in the peripartum period. Obstetric haemorrhage, sepsis, and eclampsia which are preventable or treatable are common major aetiologies of PRAKI. PRAKI is more associated with multi-parity, caesarean delivery, haemorrhage, and prolonged duration of labour. Optimal ante-natal care, health education, and prompt diagnosis and management of obstetric complications will reduce the incidence in Nigeria.
妊娠相关急性肾损伤（PRAKI）是全球急性肾损伤的常见原因。由于获得最佳产科护理的机会有限、诊断延迟和转诊不及时，PRAKI在低收入和中等收入国家（LMICs）尤其是非洲的发病率和负担仍然很高。本研究旨在确定尼日利亚两家政府医院围产期妇女中PRAKI的发病率和病因。
这是一项前瞻性研究，对分娩时入院的孕妇在产后0小时、6小时、12小时、24小时、48小时和7天测量血清肌酐。使用改善全球肾脏病预后标准定义急性肾损伤。采用二元逻辑回归确定PRAKI的预测因素。
完成研究的162名孕妇的平均年龄为30.05±1.28岁。急性肾损伤的发生率为22.2%。PRAKI的病因包括产科出血（66.7%）、子痫（19.4%）和败血症（13.9%）。17名（47.2%）患者为1期PRAKI，12名（33.3%）为2期PRAKI，7名（19.4%）为3期PRAKI。与PRAKI显著相关的因素有产次（p=<0.001）、剖宫产（p=<0.001）、失血过多（p=<0.001）和产程延长（p=0.002）。
围产期每5名孕妇中就有1名发生PRAKI。产科出血、败血症和子痫是PRAKI常见的主要病因，这些病因是可预防或可治疗的。PRAKI与多产次、剖宫产、出血和产程延长更为相关。最佳的产前护理、健康教育以及产科并发症的及时诊断和管理将降低尼日利亚的发病率。
