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Clinical characteristics and prognosis of pregnancy-related acute kidney injury: a case series study

  • Nephrology - Original Paper
  • Published:
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Abstract

Objective

Acute kidney injury (AKI) seriously affects the health of both pregnant women and fetuses. This study aimed to investigate the clinical characteristics and prognosis of pregnancy-related AKI (PR-AKI).

Methods

This case series study enrolled pregnant women with PR-AKI admitted to the surgical intensive care unit of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine between January 2010 and December 2020.

Results

Thirty-one PR-AKI patients were enrolled with a mean age of 29.16 ± 4.97 years. Seventeen pregnant women (54.84%) had complete recovery of renal function, 5 (16.13%) had partial recovery of renal function, 2 (6.45%) patients had no renal function improvement, and 7 (22.58%) died. Among the 31 patients with 35 fetuses, 25 (80.6%) pregnant women had poor fetal outcomes, including 5 cases of stillbirths, 5 neonatal asphyxia, 18 premature births, 10 low birth weight, and 8 deficient birth weight infants. Compared to cases with good fetal outcomes, cases with poor fetal outcomes had significantly shorter gestational weeks (39.26 ± 1.53 vs. 31.62 ± 5.50, P = 0.002), lower platelet count (217.13 ± 122.87 vs. 90.24 ± 84.88, P = 0.005), lower hemoglobin (94.19 ± 13.21 vs. 74.48 ± 20.78, P = 0.036), higher blood urea nitrogen (11.87 ± 4.28 vs. 19.47 ± 10.98, P = 0.013), and higher uric acid (262.41 ± 167.00 vs. 586.87 ± 144.52, P < 0.001).

Conclusions

The maternal renal function of women with PR-AKI might improve after treatment, but occurrence rates of adverse fetal outcomes were still high.

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Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AKI:

Acute kidney injury

PR-AKI:

Pregnancy-related acute kidney injury

CRRT:

Continuous renal replacement therapy

PE:

Preeclampsia

PPH:

Postpartum hemorrhage

PE/E:

Preeclampsia/eclampsia

HELLP:

Hemolysis–liver elevated enzymes–low platelet

TMA:

Thrombotic microangiopathy

AFLP:

Acute fatty liver in pregnancy

ICU:

Intensive care unit

KDIGO:

Kidney disease: improving global outcomes

K/DOQI:

Kidney disease outcomes quality initiative

SCr:

Serum creatinine

APACHE:

Acute physiology and chronic health evaluation

WBC:

White blood cell count

NLR:

Neutrophil/lymphocyte %

PLT:

Platelet count

HB:

Hemoglobin

BUN:

Blood urea nitrogen

ALT:

Alanine aminotransferase

AST:

Aspartate transaminase

ALB:

Albumin

NICU:

Neonatal intensive care unit

APS:

Acute physiology score

CPS:

Chronic health score

CKD:

Chronic kidney disease

DIC:

Disseminated intravascular coagulation

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Acknowledgements

We would like to acknowledge the whole team members involved in the management.

Funding

This study has been conducted with the support of The Western Medicine Guidance Project of Shanghai Science and Technology Commission, grant no. 19411968000, and supported by grants to FJL from the Shanghai Municipal Health Commission (201940255) and the Shanghai Scientific and Technological Committee (19411968000).

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Authors and Affiliations

  1. Departments of Nephrology and Rheumatology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China

    Wei Lu, Min-Jie Hu, Dong-Dong Zhu, Fu-Jun Lin & Hai-Dong Huang

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  1. Wei Lu
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  2. Min-Jie Hu
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  3. Dong-Dong Zhu
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Contributions

HMJ and ZDD: carried out the retrospective review of the data, participated in the design, writing and organization of the manuscript. LW, HHD and LFJ: conceived of the study and designed of it. HMJ, LFJ and ZDD: participated in the collect and analysis data of the case. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Wei Lu or Hai-Dong Huang.

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Conflict of interest

None of the authors have any competing interest to declare.

Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted with the Bioethics Committee of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine who determined that our study did not need ethical approval. A Bioethics Committee’s official statement of ethical approval was granted from the Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine. The study was conducted according to the principles of the Declaration of Helsinki and its amendments.

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Lu, W., Hu, MJ., Zhu, DD. et al. Clinical characteristics and prognosis of pregnancy-related acute kidney injury: a case series study. Int Urol Nephrol 55, 2249–2255 (2023). https://doi.org/10.1007/s11255-023-03484-6

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