TITLE:
Obstetrical Acute Kidney Injury: 25 Years’ Experience from Nephrology Care Unit in Pakistan
AUTHORS:
Rubina Naqvi, Ejaz Ahmed, Rashid Sheikh, Adib Rizvi
KEYWORDS:
AKI, Obstetrical, Pregnancy Related, ACN
JOURNAL NAME:
Open Access Library Journal,
Vol.2 No.8,
August
13,
2015
ABSTRACT: Objective: We aim to report observations from patients who developed acute
kidney injury after complicated obstetrics and referred to our institution. Patients
and Methods: Observational cohort of patients identified as having acute kidney
injury (AKI) in obstetrical situation, at a tertiary center in Pakistan, from January
1990-December 2014. AKI was defined according to RIFLE criteria and patients fall
from Risk to Loss category on arrival. On ultrasonography, all women had normal
size non obstructed kidneys, and no other co morbid. Results: Between Jan. 1990
to Dec. 2014, 1441 (which is 25.62% of total AKI) women with obstetrical AKI registered
to this hospital. Most common causes were peripartal excessive blood loss, abruptio
placentae, intra uterine fetal death, followed
by sepsis, pre-eclampsia, eclampsia, abortions, surgical trauma, exposure to nephrotoxic
antimicrobials and hemolysis with blood transfusion reaction. There was frequent
coexistence of more than one reason in majority of patients. Acute cortical necrosis
(ACN) reported on ultrasonography in 420 and on biopsy in 87 women. Renal replacement
therapy was required on arrival in 94% cases. Complete renal recovery observed in
30.98%, while 12.14% expired during acute phase, renal replacement therapy beyond
90 days required in 20.21% and 17.67% disappeared either in state of partial recovery
or in the beginning, refusing renal replacement altogether. We divided the population
in four groups, from 1990-1999 (10 years), then 2000-2004, 2005-2009 and 2010-2014,
each 5 years, and then we compared if there is any change in trends during different
time periods. Conclusion: In this part of world, poor health infra structure still
causes complications in obstetrical situation which can result deaths in young women
or requirement for lifelong renal replacement.