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Kidney Week

Abstract: SA-PO518

Preeclampsia an Under Recognised Cause of AKI in Pregnancy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ramachandran, Raja, Nehru Hospital, Chandigarh, India
  • Gupta, Krishan Lal L., Postgraduate Institute of Medical Education & Research, Chandigarh, India
  • Jha, Vivekanand, George Institute for Global Health, New Delhi, India
Background

Obstetric acute kidney injury (AKI) constitutes about 8-12% of all AKI in developing countries, with blood loss and sepsis as the main causes. Reliance on clinical parameters alone may lead to underestimation of the prevalence of preeclampsia (PE) in those with AKI, and use of biomarkers may help identify more cases.

Methods

All patients with obstetric AKI referred to the nephrology unit from September 2015 to August 2017 were evaluated. PE was diagnosed as clinical (cPE) in the presence of new onset of hypertension and proteinuria (≥ 1+ on dipstick) or hypertension and end-organ dysfunction with or without proteinuria after 20 weeks of gestation in a previously normotensive woman; and serological (sPE) on the basis of soluble fms-like tyrosine kinase(FLT1)/placental growth factor (PIGF) ratio of > 85 (<34 weeks of gestation) and > 110 (≥34 weeks of gestation) when clinical findings were indeterminate. Patients with pre-existing CKD or known systemic illnesses were excluded. We evaluated 6-month maternal and fetal outcomes in all patients.

Results

Out of a total of 73 patients seen during the study, 64 (87.7%) were seen in third trimester/postpartum period. The mean age was 26.38±3.92 (range 19-38) years. Thirty-six (49%), 34 (47%), and 57 (78%) patients had evidence of blood loss, sepsis and HUS respectively. cPE was diagnosed in 19 (30%) cases, and an additional 11 (17%) showed evidence of sPE. Fourteen (47%), 11 (37%) and 27 (90%) patients with PE had haemorrhage, sepsis and of HUS respectively. A total of 5 (17%) patients died, and 10 (33%) failed to recover from AKI. Only 6 (20%) had a successful fetal outcome.

Conclusion

Use of clinical criteria alone leads to under-diagnosis of PE in patients with obstetric AKI in developing countries. Sepsis, blood loss and AKI mask the clinical manifestations.

Funding

  • Private Foundation Support