SUN-169 Maternal and Fetal outcomes in woman with pregnancy associated acute kidney injury (PR-AKI): Single centre experience from developing country

Abstract

The incidence of PR-AKI has been declining, but it remains a serious problem due to its association with significant adverse maternal and foetal outcomes. However, the detailed impact of PR-AKI on pregnancy outcomes (maternal & foetal) is sparse from developing countries. The aim of the present study is to evaluate the maternal and foetal outcomes in patients with PR-AKI from our centre. Four thousands seven hundred forty one (4741) pregnant women were enrolled from November 2014 to July 2016. They were screened for AKI. The causes of AKI, need for dialysis, maternal and foetal outcomes were analysed individually. All patients with PR-AKI were followed for three month or longer to determine the recovery of renal function or progression to chronic kidney disease (CKD). Of 4741 pregnant women, 132 patients developed acute kidney injury (2.78%). In the majority (91.6%), AKI developed in late 3rd trimester and postpartum period. Timing of PR-AKI is shown in Figure-1. Preeclampsia was the most common cause of PR-AKI (46.9%). The causes of PR-AKI are shown in Figure-2. Conservative management was given in 70(53%) patients and 62(47%) required hemodialysis along with conservative treatment. Normal vaginal delivery occurred in 63(47.7%) and 60(45.5%) patients underwent lower segment caesarean sections (LSCS) delivery. Maternal mortality was observed in 8(6.1%) cases, due to fulminant hepatitis (4), puerperal sepsis (3) and post- abortal sepsis in (1) cases. We noted complete recovery of renal function in 118(89.4%) cases. Puerperal sepsis was the sole cause of patchy cortical necrosis in 5(3.7%) cases. At three month or longer follow up, 6(4.5%) patients developed chronic kidney disease (CKD) and patchy cortical necrosis was the main cause of progression to CKD. Out of 6 cases of CKD, 3 patients progressed to end stage renal disease (ESRD) due to patchy cortical necrosis (2), and class V lupus nephritis in (1) patients. Foetal mortality was noted in 31(23.5%) due to intrauterine death (17.5%) and prematurity (6%). Full term delivery was observed in 47(35.6%) patients and premature delivery in 54(40.9%) cases.Figure 2Causes of PR-AKI durring pregnancy (n=132).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Despite decreasing incidence of PR-AKI, foetal morbidity and mortality is high. Thus, our results revealed foetal outcomes is more grave than maternal outcomes in women with PR-AKI.