Skip to main content

Advertisement

SpringerLink
Log in

Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014–2016)

  • Original Article
  • Published:
Journal of Nephrology Aims and scope Submit manuscript

Abstract

Introduction

There are numerous reports in the literature describing acute kidney injury in pregnancy (P-AKI) due to various obstetric complications. However, there is a dearth of studies on AKI related to pregnancy-specific disorders from India. We aimed to analyze clinical features and outcome of P-AKI related to pregnancy-specific disorders compared to total pregnancy, in India.

Method

All pregnant women attending the department of Obstetrics and Gynecology from November 2014 to July 2016 were screened for AKI based on: (1) sudden elevation of serum creatinine ≥ 1 mg/dl; (2) oligoanuria for > 12 h; and (3) need for dialysis. The detailed clinical profile of AKI in patients with preeclampsia/eclampsia (PE/E), hemolysis/elevated liver enzymes/low platelet count (HELLP) syndrome, acute fatty liver of pregnancy (AFLP), and pregnancy-associated thrombotic microangiopathy (P-TMA) was analyzed. Laboratory investigations included: complete blood count, renal function tests, urinalysis, coagulation profile (platelet count, INR, prothrombin time and activated partial thromboplastin time), and immunological assay (C3, C4, ANA, anti-dsDNA antibody, antiphospholipid antibody). Contrast-enhanced CT scan of kidney ureter and bladder (KUB) and renal biopsy were performed in selected cases. Maternal and fetal outcome were analyzed individually. The patients were followed for 3 months or longer to determine the recovery of renal function or progression to chronic kidney disease (CKD).

Results

Overall, 4741 pregnant women (mean age 26.8 ± 4.8 years) were evaluated for AKI. P-AKI was found in 132/4741 (2.78%) patients. In the majority (91.6%), AKI developed in the late 3rd trimester and post-partum period. P-AKI was related to obstetric complications (in 61.4%), pregnancy-specific disorders (in 57.5%) and miscellaneous factors (7.5%). Puerperal sepsis, ante-partum and post-partum hemorrhage were contributing factors for P-AKI in 34 (25.8%), 11 (8.3%) and 28 (21.2%) patients, respectively. P-AKI due to pregnancy-specific disorders developed in 76/4741 patients, i.e. in 1:62 pregnancies. PE/E was the cause of P-AKI in 62 patients (46.9%) followed by HELLP syndrome in 9 (6.8%) and AFLP in 05 (3.8%). P-TMA causing AKI was not observed. Complete recovery of renal function occurred in 89.4% of patients while 6 (4.6%) progressed to CKD (ESRD: 3 and CKD stage IV: 3). Maternal mortality was 6%. Puerperal sepsis was the sole cause of patchy cortical necrosis in 5 (3.7%) cases. Premature delivery occurred in 40.9% patients and full-term delivery in 35.6%. Perinatal mortality was 23.5%, mainly due to intrauterine death (17.5%) and prematurity (6%).

Conclusion

PE/E was the commonest cause of P-AKI in our study, similar to the situation in developed countries. Post-partum hemorrhage was the second-most common (21.5%) cause. Puerperal sepsis contributed to AKI in one-fourth of pregnant women. P-TMA was not recorded in this study and AFLP was an uncommon cause of P-AKI in our country. Renal function returned to normal in all patients with P-AKI due to pregnancy-specific disorders. However, perinatal mortality was high despite the good prognosis of P-AKI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Stratta P, Besso L, Canavese C, Grill A, Todros T, Benedetto C et al (1996) Is pregnancy-related acute renal failure a disappearing entity? Ren Fail 18:575–584

    Article  CAS  PubMed  Google Scholar 

  2. Hilderband AM, Liu K. Shariff SZ. Ray JG. Sontrop JM, Clark WF. Haldunewich, Garg AX (2015) Characteristics and outcome of AKI treated with dialysis during pregnancy and the postpartum period. J AM Soc Nephrol 26(12):3085–3091. https://doi.org/10.1681/ASN.2014100954

    Article  CAS  Google Scholar 

  3. Prakash J, Kumar H, Sinha DK, Kedalaya PG, Pandey LK, Srivastava PK et al (2006) Acute renal failure in pregnancy in a developing country: twenty years experience. Ren Fail 28:309–313

    Article  PubMed  Google Scholar 

  4. Jayakumar M, Prabahar MR, Fernando EM, Manorajan R, Venkatraman R, Balaraman V (2006) Epidemiologic trend changes in acute renal failure: a tertiary center experience from South India. Ren Fail 28:405–410. https://doi.org/10.11080/08860220600689034

    Article  CAS  PubMed  Google Scholar 

  5. Prakash J, Niwas SS, Parekh A, Pandey LK, Sharatchandra L, Arora P, Mahapatra AK (2010) Acute kidney injury in late pregnancy in developing countries. Ren Fail 32:309–313. https://doi.org/10.3109/08860221003606265

    Article  PubMed  Google Scholar 

  6. Kumar KS, Krishna CR, Kumar VS (2006) Pregnancy related acute renal failure. J Obstet Gynaecol India 56:308–310

    Google Scholar 

  7. Goplani KR, Shah PR, Gera DN et al (2008) Pregnancy related acute renal failure: a single center experience. Indian J Nephrol 18:17–21. https://doi.org/10.4103/0971-4065.41283

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Prakash J, Vohra R, Wani IA, Murthy AS, Srivastva PK, Tripathi K et al (2007) Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries. a single-centre experience of 22 years from Eastern India. Nephrol Dial Transpl 22:1213–1217

    Article  Google Scholar 

  9. Machado S, Figueiredo N, Borges A et al (2012) Acute kidney injury in pregnancy: a clinical challenge. J Nephrol 25(1):19–30. https://doi.org/10.5301/jn.5000013

    Article  PubMed  Google Scholar 

  10. Callghan WM, Creanga AA, Kuklina EV (2012) Severe maternal morbidity among delivery and postpartum hospitalization in the United States. Obstet Gynecol 120(5):1029–1036. https://doi.org/10.1097/AOG.0b013e31826d60c5

    Article  Google Scholar 

  11. Mehrabadi A, Liu S.Bartholomew S (2014) Hypertensive disorders of pregnancy and the recent increase in obstetric renal failure in Canada: population based retrospective cohort study. BMJ 349:g4731–g4731

    Article  PubMed  PubMed Central  Google Scholar 

  12. Prakash J, Pant P, Prakash S, Sivasankar M, Vohra R, Doley PK, Pandey LK, Singh U (2016) Changing picture of acute kidney injury in pregnancy:Study of 259 cases over a period of 33 years. Indian J Nephrol 26(4):262–267. https://doi.org/10.4103/0971-4065.161018

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kuklina EV, Ayala C, Callaghan WM (2009) Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol 113:1299–1306. https://doi.org/10.1097/AOG.0b013e3181a45b25

    Article  PubMed  Google Scholar 

  14. Sibai BM, Ramadan MK (1993) Acute renal failure in pregnancies complicated by hemolysis, elevated liver enzymes, and low platelets. Am J Obstet Gynecol 168:1682–1687 (discussion 1687–90)

    Article  CAS  PubMed  Google Scholar 

  15. Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA (1993) Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 169:1000–1006

    Article  CAS  PubMed  Google Scholar 

  16. Peng DZ (1993) Acute renal failure in severe pregnancy induced hypertension: a report of 19 cases. Zhonghua Fu Chan Ke Za Zhi 28(5):281–283

    CAS  PubMed  Google Scholar 

  17. Hachim K, Badahi K, Benghanem M, Fatihi EM, Zahivi K, Ramdani B et al (2001) Obstetrical acute renal failure Experience of the nephrology department, central university hospital Ibn Rochd. Casablanca Nephrologie 22:29–31

    CAS  PubMed  Google Scholar 

  18. Krishna A, Singh R, Prasad N, Gupta A, Bhadauria D, Kaul A, Sharma RK, Kapoor D (2015) Maternal, fetal and renal outcomes of pregnancy-associated acute kidney injury requiring dialysis. Indian J Nephrol 25(2):77–81. https://doi.org/10.4103/0971-4065.136890

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Ansari MR, Laghari MS, Solangi KB (2008) Acute renal failure in pregnancy: one year observational study at Liaquat University Hospital, Hyderabad. J Pak Med Assoc 58:61–64

    PubMed  Google Scholar 

  20. Drakeley AJ, Le Roux PA, Anthony J, Penny J (2002) Acute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit. Am J Obstet Gynecol 186:253–256

    Article  PubMed  Google Scholar 

  21. Gul A, Aslan H, Cebeci A, Polat I, Ulusoy S, Ceylan Y (2004) Maternal and fetal outcomes in HELLP syndrome complicated with acute renal failure. Ren Fail 26:557–562

    Article  PubMed  Google Scholar 

  22. Aggarwal RS, Mishra VV, Jasani AF, Gumber M (2014) Acute renal failure in pregnancy: our experience. Saudi J Kidney Dis Transpl 25(2):450–455

    Article  PubMed  Google Scholar 

  23. Syed Munib (2008) Sheraz Jamal Khan Outcomes of Pregnancy related acute renal failure. RMJ 33(2):189–192

    Google Scholar 

  24. Khanal N, Ahmed E, Akhtar F (2010) Factors predicting the outcome of acute renal failure in pregnancy. J Coll Phys Surg Pak 20(9):599–603. https://doi.org/09.2010/JCPSP.599603

    Google Scholar 

  25. Knight M, Nelson-Piercy C, Kurinczuk JJ et al (2008) A prospective national study of acute fatty liver of pregnancy in the UK. Gut 57(7):951–956. https://doi.org/10.1136/gut.2008.148676

    Article  CAS  PubMed  Google Scholar 

  26. Reyes H, Sandoval L, Wainstein A, Ribalta J, Donoso S, Smok G et al (1994) Acute fatty liver of pregnancy: a clinical study of 12 episodes in 11 patients. Gut 35:101–106

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Matthews JH, Benjamin S, Gill DS et al (2009) Pregnancy-associated thrombocytopenia: definition, incidence and natural history. Acta Haematol 84(1):24–29

    Article  Google Scholar 

  28. Patel ML, Sachan R, Radheshyam N, Sachan P (2013) Acute renal failure in pregnancy: tertiary centre experience from north Indian population. Niger Med J 54(3):191–195. https://doi.org/10.4103/0300-1652.114586.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Najar MS, Shah AR, Wani IA, Reshi AR, Banday KA, Bhat MA et al (2008) Pregnancy related acute kidney injury: a single center experience from the Kashmir Valley. Indian J Nephrol 18:159–161. https://doi.org/10.4103/0971-4065.45291

    Article  PubMed  PubMed Central  Google Scholar 

  30. Chugh KS, Singhal PC, Sharma BK, Pal Y, Mathew MT, Dhall K, Datta BN (1976) Acute renal failure of obstetric origin. Obstet Gynecol 48:642–646

    CAS  PubMed  Google Scholar 

  31. Prakash J, Pant P, Singh Anil K et al (2015) Renal cortical necrosis is a disappearing entity in obstetric kidney injury in developing countries. Our three decades of experience from India. Ren Fail 37:1185–1189. https://doi.org/10.3109/0886022X.2015.1062340

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    Jai Prakash

  2. Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    Vivek C. Ganiger, Mohammad Iqbal & Deba Prasad Kar

  3. Department of Medicine, TNMC, Mumbai, Maharastra, India

    Suraj Prakash

  4. Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    Usha Singh

  5. Department of Radiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    Ashish Verma

Authors
  1. Jai Prakash
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vivek C. Ganiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suraj Prakash
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammad Iqbal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Deba Prasad Kar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Usha Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ashish Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jai Prakash.

Ethics declarations

Conflict of interest

The above mentioned authors declare that they have no conflict of interest for this original article.

Ethical approval

The study was approved by the institutional ethical committee.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Research involving human and animal participants

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Additional information

This article is part of the topical collection on Obstetric Nephrology.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Prakash, J., Ganiger, V.C., Prakash, S. et al. Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014–2016). J Nephrol 31, 79–85 (2018). https://doi.org/10.1007/s40620-017-0466-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40620-017-0466-y

Keywords

Search

Navigation