Abstract: SA-PO041

Clinical Profile of Pregnancy Related AKI (PRAKI): A Single Center Experience

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Author

  • Patil, Mayur Vinayakrao, Institute of Kidney Disease and Research Centre and Institute of Transplantation Sciences, Ahmedabad, India
Background

Acute renal failure (ARF) of obstetric origin is one of the most common complication of pregnancy and leads to poor maternal and fetal outcome. The incidence of PRAKI in developed country is 1 in 20,000 pregnancies, where as in developing country like India is 1 in 50. Septic abortion, poor follow up of pregnancy, limited screening of pregnant patients with hypertensive complications and late referrals to tertiary center are responsible for high incidence of ARF in developing countries.

Methods

The study was conducted at government aided tertiary care hospital between April 2016 to March 2017. A total 1021 patients of ARF were admitted out of which 96 were PRAKI. ARF was defined according to KIDIGO guidelines. Renal biopsy was performed if the patient was oliguric or creatinine still >2mg/dl at the end of three weeks.

Results

The incidence of PRAKI was 9.4%. Most common age group was 24-29 years(53.13%). 45.83% patients presented in late pregnancy while 36.46% presented in postpartum period. Antenatal care was recieved by only 30.21% patients. 25% patients required termination of pregnancy. Most common cause for PRAKI was puerperal sepsis followed by pre eclampsia. 18.75% patients were managed conservatively while 69.79% were kept on intermittent hemodialysis and 11.46% required SLED/CRRT. Acute patchy cortical necrosis was most common histological finding, others were thrombotic microangiopathy and glomerulonephritis. Complete recovery occured in 43.75%, whereas 16.67% had partial recovery (became dialysis independent but with persistent renal impairment), 19.79% were kept on renal replacement therapy. Maternal mortality was seen in 19.79% of cases.

Conclusion

In our study, puerperal sepsis was the most common etiological factor for pregnancy-related AKI. Sepsis, thrombocytopenia, disseminated intra-vascular coagulation were associated with increased mortality.