Acute Kidney Injury in Pregnancy: A Single-Center Study in Tunisia

Abstract

Acute kidney injury is a rare but serious complication of pregnancy. It is still common in developing countries. The causes can be varied. It is imperative to distinguish these conditions to make appropriate therapeutic decisions which can be lifesaving for the mother and fetus. This study examined the incidence and etiology of acute kidney injury in pregnancy, the morbidity, fetomaternal mortality, and renal prognosis among pregnant patients developing acute kidney injury. This is a retrospective observational study involving cases of acute kidney injury during pregnancy and hospitalized in our department from 1995 to 2015. The study involved 10 patients. The average age of patients was 31.6 years. Personal history of preeclampsia was found in 2 patients. The average term of pregnancy in which appeared the acute kidney injury was 33 weeks. All patients had preeclampsia. Five of them had a retro-placental hematoma, 2 had eclampsia and another post-partum hemorrhage. Five patients underwent renal biopsy for a persistent acute kidney injury with an average delay of 26 days. The histological results were: partial cortical necrosis in one case, thrombotic microangiopathy in two cases, acute tubular necrosis in one case, and membranoproliferative glomerulonephritis in one case. Six of our patients had an antihypertensive treatment. Seven patients have required renal replacement therapy. The ultimate evolution was good in 9 patients with recovery of diuresis and total recovery of renal function. Only one patient had kept with advanced renal failure requiring hemodialysis. She has been transplanted after 2 years with normal graft function. The pregnancy care and quality of access to care remain fundamental to prevent complications of pregnancy, including acute kidney injury.