SUN-008 ACUTE KIDNEY INJURY IN PATIENTS WITH PREGNANCY INDUCED HYPERTENSION: A SINGLE CENTRE EXPERIENCE

Abstract

Pregnancy induced hypertension (PIH) remains a major cause of feto-maternal morbidity and mortality especially in developing countries. The severe forms (severe pre-eclampsia and eclampsia) are potentially life threatening and may be accompanied by multi-organ involvement. AKI is one of the complications of PIH. We present a single center, 8 year retrospective review of 223 patients with PIH. We aim to determine the spectrum of renal dysfunction in patients with PIH. Clinical records of cases managed for pregnancy induced hypertension at the Obafemi Awolowo University Teaching Hospitals’ Complex, Ile Ife between Jan 2008 and Jan 2016 were retrieved. A proforma was used to collect information on their demographics, obstetric data, and laboratory parameters, length of hospital stay as well as maternal, renal, and fetal outcomes. Patients with history or clinical evidence of hypertension before 20 weeks gestation; diabetes mellitus, or chronic kidney disease prior to pregnancy were excluded from the analysis. Renal outcomes were defined as Acute Kidney Injury (AKI) or the need for renal replacement therapy (RRT). Data obtained were analyzed using Statistical package for Social Sciences (SPSS) version 22. There were a total of 223 cases admitted for PIH during the 8 year study period. Mean age at presentation was 29.0 (±5.8) years. Estimated gestational age (EGA) at presentation ranged between 24 – 44 weeks with a mean EGA of 35.2(±4.1) weeks, 48.8% had severe pre-eclampsia while 40.8% of the study population had eclampsia. Mean systolic and diastolic BP at presentation were 172±24 mmHg and 110±17 mmHg respectively. Fifty one patients (22.9%) had an admission serum Cr ≥ 90µmol/L. Thirty two patients developed AKI (14.3%). Their mean serum creatinine at presentation was 204.1± 76.5µmol/L. Of the 32 patients with AKI, 18 (56.3%) had oliguric AKI. Four patients (12.5%) required RRT only, 6 (18.8%) required both RRT and ICU admission while the remaining 22 (68.7%) were managed conservatively. All our patients had at least 1+ proteinuria by dipstick at presentation. Majority of the patients were delivered at term by emergency caesarian section. AKI remains an important complication of PIH and oliguric AKI is the commonest presentation in the studied population.