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.
Similar content being viewed by others
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
References
Taber-Hight E, Shah S (2020) Acute kidney injury in pregnancy. Adv Chronic Kidney Dis 27:455–460. https://doi.org/10.1053/j.ackd.2020.06.002
Cooke WR, Hemmila UK, Craik AL, Mandula CJ, Mvula P, Msusa A et al (2018) Incidence, aetiology and outcomes of obstetric-related acute kidney injury in Malawi: a prospective observational study. BMC Nephrol 19:25. https://doi.org/10.1186/s12882-018-0824-6
Gaber TZ, Shemies RS, Baiomy AA, Aladle DA, Mosbah A, Abdel-Hady ES et al (2021) Acute kidney injury during pregnancy and puerperium: an Egyptian hospital-based study. J Nephrol 34:1611–1619. https://doi.org/10.1007/s40620-021-01133-8
Prakash J, Prakash S, Ganiger VC (2019) Changing epidemiology of acute kidney injury in pregnancy: a journey of four decades from a developing country. Saudi J Kidney Dis Transplant 30:1118–1130. https://doi.org/10.4103/1319-2442.270268
Vijayan M, Avendano M, Chinchilla KA, Jim B (2019) Acute kidney injury in pregnancy. Curr Opin Crit Care 25:580–590. https://doi.org/10.1097/MCC.0000000000000656
Huang C, Chen S (2017) Acute kidney injury during pregnancy and puerperium: a retrospective study in a single center. BMC Nephrol 18:146. https://doi.org/10.1186/s12882-017-0551-4
Gopalakrishnan N, Dhanapriya J, Muthukumar P, Sakthirajan R, Dineshkumar T, Thirumurugan S et al (2015) Acute kidney injury in pregnancy–a single center experience. Ren Fail 37:1476–1480. https://doi.org/10.3109/0886022X.2015.1074493
Patel ML, Sachan R, Radheshyam SP (2013) Acute renal failure in pregnancy: tertiary ce-ntre experience from north Indian population. Niger Med J 54:191–195. https://doi.org/10.4103/0300-1652.114586
Liu D, He W, Li Y, Xiong M, Wang L, Huang J et al (2019) Epidemiology of acute kidney injury in hospitalized pregnant women in China. BMC Nephrol 20:67. https://doi.org/10.1186/s12882-019-1255-8
Liu Y, Ma X, Zheng J, Liu X, Yan T (2017) Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 17:235. https://doi.org/10.1186/s12884-017-1402-9
Stucker F, Ponte B, Tataw J, Martin PY, Wozniak H, Pugin J et al (2015) Efficacy and safety of citrate-based anticoagulation compared to heparin in patients with acute kidney injury requiring continuous renal replacement therapy: a randomized controlled trial. Crit Care 19:91. https://doi.org/10.1186/s13054-015-0822-z
Shu H, Nie F (2021) Clinical characteristics and prognosis of postpartum acute kidney injury. J Int Med Res 49:300060520988388. https://doi.org/10.1177/0300060520988388
Mahesh E, Puri S, Varma V, Madhyastha PR, Bande S, Gurudev KC (2017) Pregnancy-related acu-te kidney injury: an analysis of 165 cases. Indian J Nephrol. 27:113–117. https://doi.org/10.4103/0971-4065.194394
Arrayhani M, El Youbi R, Sqalli T (2013) Pregnancy-related acute kidney injury: experience of th-e nephrology unit at the university hospital of fez, morocco. ISRN Nephrol 2013:109034. https://doi.org/10.5402/2013/109034
Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120:c179–c184. https://doi.org/10.1159/000339789
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829
Dc B, Jp T (2008) Severity scoring systems in the critically ill. Continu Educ Anaesth Crit Care Pain. 8:181–185. https://doi.org/10.1093/bjaceaccp/mkn033
Apgar V (1953) A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 32:260–267
Kattwinkel J (2011) Textbook of neonatal resuscitation, 6th edn. American Academy of Pediatrics, Elk Grove Village
Report of the American College of Obstetricians and Gynecologists’ Task Forceon Neonatal Encephalopathy (2014) Executive summary: neonatal encephalopathy and neurologic outcome, second edition. Report of the American college of obstetricians and gynecologists' task force on neonatal encephalopathy. Obstet Gynecol. 123:896–901. https://doi.org/10.1097/01.AOG.0000445580.65983.d2.
Liu YM, Bao HD, Jiang ZZ, Huang YJ, Wang NS (2015) Pregnancy-related acute kidney injury an-d a review of the literature in China. Intern Med 54:1695–1703. https://doi.org/10.2169/internalmedicine.54.3870
National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney dis 39:S1-266
Wu VC, Huang TM, Lai CF, Shiao CC, Lin YF, Chu TS et al (2011) Acute-on-chronic kidney injur-y at hospital discharge is associated with long-term dialysis and mortality. Kidney Int 80:1222–1230. https://doi.org/10.1038/ki.2011.259
Aggarwal RS, Mishra VV, Jasani AF, Gumber M (2014) Acute renal failure in pregnancy: our experience. Saudi J Kidney Dis Transplant 25:450–455. https://doi.org/10.4103/1319-2442.128621
Kabbali N, Tachfouti N, Arrayhani M, Harandou M, Tagnaouti M, Bentata Y et al (2015) Outcome assessment of pregnancy-related acute kidney injury in Morocco: a national prospective study. Saudi J Kidney Dis Transplant. 26:619–624. https://doi.org/10.4103/1319-2442.157426
Hassan I, Junejo AM, Dawani ML (2009) Etiology and outcome of acute renal failure in pregnancy. J Coll Phys Surg-Pakistan 19:714–717
Godara SM, Kute VB, Trivedi HL, Vanikar AV, Shah PR, Gumber MR et al (2014) Clinical profile and outcome of acute kidney injury related to pregnancy in developing countries: a single-center study from India. Saudi J Kidney Dis Transplant 25:906–911. https://doi.org/10.4103/1319-2442.135215
Young MF, Oaks BM, Tandon S, Martorell R, Dewey KG, Wendt AS (2019) Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann N Y Acad Sci 1450:47–68. https://doi.org/10.1111/nyas.14093
Zhou F, Xu T, Deng C, Yu H, Wang X (2019) Severe thrombocytopenia in pregnancy: a case series from west China. Clin Exp Med 19:495–503. https://doi.org/10.1007/s10238-019-00575-6
Le TM, Nguyen LH, Phan NL, Le DD, Nguyen HVQ, Truong VQ et al (2019) Maternal serum uric acid concentration and pregnancy outcomes in women with pre-eclampsia/eclampsia. Int J Gynaecol Obstet 144:21–26. https://doi.org/10.1002/ijgo.12697
Arora N, Mahajan K, Jana N, Taraphder A (2010) Pregnancy-related acute renal failure in eastern India. Int J Gynaecol Obstet 111:213–216. https://doi.org/10.1016/j.ijgo.2010.06.026
Krane NK, Hamrahian M (2007) Pregnancy: kidney diseases and hypertension. Am J Kidney Dis 49:336–345. https://doi.org/10.1053/j.ajkd.2006.10.029
Prakash J, Ganiger VC (2017) Acute kidney injury in pregnancy-specific disorders. Indian J Nephrol. 27:258–270. https://doi.org/10.4103/0971-4065.202406
Garcia-Romero CS, Guzman C, Cervantes A, Cerbon M (2019) Liver disease in pregnancy: Medic-al aspects and their implications for mother and child. Ann Hepatol 18:553–562. https://doi.org/10.1016/j.aohep.2019.04.009
Shi Y, Wu H, Zhou X, Xu Q, Zheng L, Li D et al (2021) Analysis of clinical characteristics and genetic testing in patients with acute fatty liver of pregnancy: a retrospective study. BMC Pregnancy Childbirth 21:617. https://doi.org/10.1186/s12884-021-04095-8
Lunn MR, Obedin-Maliver J, Hsu CY (2015) Increasing incidence of acute kidney injury: also a problem in pregnancy? Am J Kidney Dis 65:650–654. https://doi.org/10.1053/j.ajkd.2014.11.007
Rao S, Jim B (2018) Acute kidney injury in pregnancy: the changing landscape for the 21st Century. Kidney Int Rep. 3:247–257. https://doi.org/10.1016/j.ekir.2018.01.011
Sivakumar V, Sivaramakrishna G, Sainaresh VV, Sriramnaveen P, Kishore CK, Rani ChS et al (2011) Pregnancy-related acute renal failure: a ten-year experience. Saudi J Kidney Dis Transplant 22:352–353
Prakash J, Ganiger VC, Prakash S, Iqbal M, Kar DP, Singh U et al (2018) Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014–2016). J Nephrol 31:79–85. https://doi.org/10.1007/s40620-017-0466-y
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).
Author information
Authors and Affiliations
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
Ethics declarations
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.
Consent to participate
Informed consent was obtained from all subjects.
Consent for publication
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-023-03484-6