Study of Characteristics and Renal Outcome in Three Months Period Following Postpartum Acute Kidney Injury Requiring Hemodialysis

Abstract

Background: Postpartum acute kidney injury (AKI) is one of the serious complications of pregnancy and constitutes an important cause of obstetric AKI. Severe acute kidney injury in the postpartum period often necessitates initiation of short-term dialysis. It may be associated with varying degree of morbidity and mortality in young and often otherwise healthy women. Aims of the study: The aim of the study was to characterizing renal outcome in three months period following of postpartum acute kidney injury requiring hemodialysis. Methods: This prospective observational study was carried out in the Nephrology and Medicine department of Dhaka Medical College Hospital, Dhaka, from July 2019 to December 2020. A total of 64 postpartum AKI patients who required hemodialysis were enrolled in this study as study population. Demographic, clinical and laboratory data of the patients, outcome variables included survival at hospital, discharge and estimated glomerular filtration rate (eGFR) at three months of follow up were recorded. Results: In this study, 54(84.4%) patients survived and maternal mortality was 15.6%. The mean age was 26.13±4.59 in alive group and 24.3±4.95 years in death group. Majority of patients were multigravida and had LUCS delivery. Puerperal sepsis (70.4% in alive group and 100.0% in death group) was the most prevalent cause followed by obstetric hemorrhage (APH/PPH) and pre-eclampsia/eclampsia. The mean S. Creatinine was 6.66±1.42 (mg/dl) in alive group and 6.74±1.12 (mg/dl) in death group. Out of 48 patients who were followed up at three months, 47.92% had eGFR <60ml/min/1.73m2. Duration of oligoanuria was the only predictor of eGFR<60 mL/min/1.73m2 at three months of follow up. Renal biopsy was done in ten patients out of whom 40% had thrombotic microangiopathy with renal cortical necrosis and 30% patient had renal cortical necrosis. One patient with renal cortical necrosis remained dialysis dependent at three months of follow up. ...................