Ng'ethe Wanjiku, Pulei Anne, Ondieki Diana, Amenge James, Kosgei Rose, Kayima Joshua, Osoti Alfred
Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
Department of Obstetrics and Gynaecology, Kenyatta National Hospital, Nairobi, Kenya.
PLOS Glob Public Health. 2025 Apr 8;5(4):e0004396. doi: 10.1371/journal.pgph.0004396. eCollection 2025.
Pregnancy-related acute kidney injury (PrAKI) is defined as a rapid decline in kidney function in the pregnancy or puerperal period that can result in life-threatening organ dysfunction. This study aimed to investigate socio-demographic features of critically ill women with pregnancy-related acute kidney injury as well as their maternal and foetal outcomes. Retrospective analysis of data in patients with pregnancy-related kidney injury in the obstetric critical care unit at a public tertiary referral centre in Kenya between February 2020-2023. Of the 266 patient files reviewed, pregnancy-related acute kidney was found in 203 patients. The main predisposing factors for acute kidney injury were hypertensive disorders in pregnancy (64.1%), obstetric haemorrhage (38.4%) and sepsis (36.5%). According to KDIGO (Kidney Disease Improving Global Outcomes) criteria, 44 patients presented in stage 1 (21.7%), 58 in stage 2 and 101 in stage 3 (49.8%). Patients with KDIGO stage 3 had a higher risk of high SOFA (Sequential Organ Failure Assessment) score (p =< 0.001), longer ICU stay (p = 0.008) and longer duration on ventilation (p = 0.010). Seventy-six patients underwent dialysis (37.4%). Recovery of renal function was complete in 91 patients (44.8%), partial in 41 (20.2%) with dependence on dialysis seen in 23 (23.6%). Forty-eight patients died (23.6%). Risks associated with mortality were mechanical ventilation (p = 0.001) and inotropic support (p =< 0.001) with statistically significant higher mean SOFA scores in those who died versus those who survived (12.6 ± 3.8 p =< 0.001 vs 8.6 ± 3.2). The incidence of PrAKI is still underestimated in the Kenyan setting with the majority of the patients presenting with advanced renal injury. These patients are at higher risk of adverse maternal morbidity and mortality in the critical care setting.
妊娠相关急性肾损伤（PrAKI）的定义为妊娠或产褥期肾功能迅速下降，可导致危及生命的器官功能障碍。本研究旨在调查妊娠相关急性肾损伤重症妇女的社会人口学特征及其母婴结局。对肯尼亚一家公立三级转诊中心产科重症监护病房2020年2月至2023年期间妊娠相关肾损伤患者的数据进行回顾性分析。在审查的266份患者档案中，发现203例患者患有妊娠相关急性肾损伤。急性肾损伤的主要诱发因素是妊娠期高血压疾病（64.1%）、产科出血（38.4%）和败血症（36.5%）。根据改善全球肾脏病预后组织（KDIGO）标准，44例患者处于1期（21.7%），58例处于2期，101例处于3期（49.8%）。KDIGO 3期患者发生高序贯器官衰竭评估（SOFA）评分的风险更高（p<=0.001），入住重症监护病房（ICU）的时间更长（p = 0.008），机械通气时间更长（p = 0.010）。76例患者接受了透析（37.4%）。91例患者（44.8%）肾功能完全恢复，41例（20.2%）部分恢复，23例（23.6%）依赖透析。48例患者死亡（23.6%）。与死亡相关的风险因素是机械通气（p = 0.001）和血管活性药物支持（p<=0.001），死亡患者的平均SOFA评分显著高于存活患者（12.6±3.8，p<=0.001对比8.6±3.2）。在肯尼亚，PrAKI的发病率仍被低估，大多数患者表现为晚期肾损伤。在重症监护环境中，这些患者发生不良孕产妇发病和死亡的风险更高。
