Mohammad Noor, Qazi Qudsia, Liaqat Nazia
Noor Mohammad, MBBS, MCPS(Medicine), FCPS Nephrology Associate Professor, Department of Nephrology, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan.
Qudsia Qazi, MBBS, FCPS (Obstetrics & Gynecology) Associate Professor, Department of Gynecology, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan.
Pak J Med Sci. 2024 Nov;40(10):2267-2270. doi: 10.12669/pjms.40.10.9228.
BACKGROUND & OBJECTIVE: Pregnancy related acute kidney injury (Pr-AKI) is coupled with adverse feto-maternal outcomes. Adverse perinatal outcome comprising of still births, intrauterine growth retardation, neonatal deaths are indicators of severity of underlying obstetrical conditions ending on Pr-AKI. These perinatal outcomes can also serve as potential predictors for long term outcomes of Pr-AKI. Our study aimed to determine frequencies of adverse perinatal outcomes and to evaluate adverse perinatal outcome as predictor for persistent renal injury in patients with pregnancy induced acute renal injury (Pr-AKI).
A descriptive case series including 100 women with Pr-AKI, was conducted in a tertiary care hospital of Peshawar from 1st August 2021 to 31st July 2022. Included patients were followed for three months period, from their date of delivery. Adverse perinatal outcome included stillbirths, and early neonatal deaths.
The mean age of study sample was 29.20±6.40. The pre dominant etiology for Pr-AKI was primary postpartum hemorrhage, occurring in 52% women. Still births were seen in 48% cases, while early neonatal deaths were seen in 7% cases. Adverse perinatal outcome had statistically significant association with persistent renal failure (p-0.01). Other factors having statistically significant association with persistent renal injury (PRF) were multiparity and cesarean births. (p<0.05) Association of adverse perinatal outcome with persistent renal injury persisted on multivariate logistic regression. a OR 6.14; CI 1.15-32.29, p-0.033.
Almost half of the cases with Pr-AKI have still births. Still birth in patients with Pr-AKI is associated with persistent renal injury at 12 weeks follow up period.
妊娠相关急性肾损伤（Pr-AKI）与不良母婴结局相关。不良围产期结局包括死产、胎儿宫内生长受限、新生儿死亡，这些是导致Pr-AKI的潜在产科疾病严重程度的指标。这些围产期结局也可作为Pr-AKI长期结局的潜在预测指标。我们的研究旨在确定不良围产期结局的发生率，并评估不良围产期结局作为妊娠诱导急性肾损伤（Pr-AKI）患者持续性肾损伤预测指标的价值。
2021年8月1日至2022年7月31日，在白沙瓦的一家三级护理医院开展了一项描述性病例系列研究，纳入100例Pr-AKI女性患者。从分娩日期开始，对纳入患者进行为期三个月的随访。不良围产期结局包括死产和早期新生儿死亡。
研究样本的平均年龄为29.20±6.40岁。Pr-AKI的主要病因是原发性产后出血，52%的女性发生该情况。48%的病例出现死产，7%的病例出现早期新生儿死亡。不良围产期结局与持续性肾衰竭具有统计学显著相关性（p = 0.01）。与持续性肾损伤（PRF）具有统计学显著相关性的其他因素包括多胎妊娠和剖宫产（p<0.05）。在多因素逻辑回归分析中，不良围产期结局与持续性肾损伤的相关性仍然存在。优势比为6.14；置信区间为1.15 - 32.29，p = 0.033。
几乎一半的Pr-AKI病例出现死产。Pr-AKI患者的死产与随访12周时的持续性肾损伤相关。
