Shemies Rasha, Nagy Eman, Younis Dalia, Gaber Tamer, Abozeid Fatma
Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt.
Gastroenterology and Hepatology Unit, Mansoura Specialized MedicalHospital, Mansoura University, Mansoura, Egypt.
Sci Rep. 2025 Sep 18;15(1):32603. doi: 10.1038/s41598-025-19485-7.
Pregnancy related-acute kidney injury (Pr-AKI) is a major public health problem that poses serious maternal and fetal risks, particularly in low-resource settings. Liver affection including conditions unique to pregnancy such as Hyperemesis gravidarum, preeclampsia/HELLP syndrome, acute fatty liver of pregnancy or pre-existing liver conditions, can further compromise these adverse outcomes. Given the critical yet understudied nature of liver involvement in Pr-AKI, this research aimed to explore the pattern of liver affliction in women with Pr-AKI and its impact on maternal and fetal outcomes. This 5-year retrospective study included women with severe Pr-AKI (stage III) according to the KDIGO definition. The medical records of the included patients were reviewed for evidence of gestational liver disorders such as (HELLP syndrome, acute fatty liver of pregnancy (AFLP), intrahepatic cholestasis of pregnancy), or evidence of preexisting/coincidental liver disease. The patients' clinical/laboratory data and outcomes were collected and analyzed. This study of 77 pregnant women with severe Pr-AKI found a high maternal mortality rate of 18.2% and fetal mortality of 39%. 35.5% of survivors in the liver affliction group developed chronic kidney disease requiring hemodialysis. Most women presented in the third trimester with preeclampsia/HELLP syndrome, other conditions included, acute fatty liver of pregnancy and preexisting liver cirrhosis. Women with liver affection presented at older gestational ages, had higher maternal mortality, more severe hematological abnormalities and worse fetal and renal outcomes. Severe liver dysfunction was the only significant predictor of maternal mortality, which was primarily observed in patients with shock liver or pre-existing decompensated liver cirrhosis. Liver affliction is not an uncommon problem among women with Pr-AKI and it is associated with higher maternal mortality and poor fetal and renal outcomes. Further research is needed to better understand the various liver diseases that arise in pregnancy and their impact on outcomes in Pr-AKI patients.
妊娠相关急性肾损伤（Pr-AKI）是一个重大的公共卫生问题，会给母婴带来严重风险，在资源匮乏地区尤为如此。肝脏疾病，包括妊娠特有的情况，如妊娠剧吐、先兆子痫/HELLP综合征、妊娠急性脂肪肝或既往存在的肝脏疾病，会进一步加重这些不良后果。鉴于肝脏在Pr-AKI中的关键作用且尚未得到充分研究，本研究旨在探讨Pr-AKI女性患者的肝脏疾病模式及其对母婴结局的影响。这项为期5年的回顾性研究纳入了根据KDIGO定义患有严重Pr-AKI（III期）的女性。对纳入患者的病历进行审查，以寻找妊娠肝脏疾病（如HELLP综合征、妊娠急性脂肪肝（AFLP）、妊娠期肝内胆汁淤积症）的证据，或既往/并发肝脏疾病的证据。收集并分析患者的临床/实验室数据及结局。这项对77例患有严重Pr-AKI的孕妇的研究发现，孕产妇死亡率高达18.2%，胎儿死亡率为39%。肝脏疾病组中35.5%的幸存者发展为需要血液透析的慢性肾病。大多数女性在妊娠晚期出现先兆子痫/HELLP综合征，其他情况包括妊娠急性脂肪肝和既往存在的肝硬化。患有肝脏疾病的女性妊娠年龄较大，孕产妇死亡率较高，血液学异常更严重，胎儿和肾脏结局更差。严重肝功能障碍是孕产妇死亡的唯一重要预测因素，主要见于休克肝或既往失代偿性肝硬化患者。肝脏疾病在Pr-AKI女性中并非罕见问题，且与较高的孕产妇死亡率以及不良的胎儿和肾脏结局相关。需要进一步研究以更好地了解妊娠期间出现的各种肝脏疾病及其对Pr-AKI患者结局的影响。
