Abstract
Background: Pregnancy-related acute kidney injury (PRAKI) is still a common serious problem in developing countries. Insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor metalloproteinases-2 (TIMP-2) can identify critically ill patients at risk for the development of severe AKI. Aim: To identify main causes and timing of PRAKI and to study the G1 cell cycle arrest biomarkers in cases diagnosed with (PRAKI) as a diagnostic tool. Methods: 80 pregnant women diagnosed with PRAKI were recruited from a single hospital as well as 30 age-matched pregnant women with normal pregnancy participated in the present study. A urine specimen was collected from all study participants with established AKI within 24 h of ICU admission to measure [TIMP-2]*[IGFBP7]. Results: The incidence of PRAKI was 1.1%. The most common cause of PRAKI is pre-eclampsia/eclampsia spectrum (61%). Most of the cases occur in the third trimester (60%) and postpartum period (23%). At a cutoff 0.33 ng/ml, the estimated sensitivity and specificity of urinary [TIMP-2]*[IGFBP7] in predicting PRAKI is 100% (95% CI) with NPV and PPV are 100%. Conclusion: Urinary [TIMP-2]*[IGFBP7] serves as a sensitive and specific biomarker in the diagnosis of PRAKI.
Highlights
Pregnancy-related acute kidney injury (PRAKI) is still a common issue in developing countries with serious consequences on the mother and fetus [1]
Consensus definitions of AKI used in the general population can mask AKI in early disease course as glomerular filtration rate (GFR) increases significantly during pregnancy resulting in lower serum creatinine as compared with healthy nonpregnant women, so they have not been validated in pregnancy
We identify the main causes and timing of PRAKI and to study the G1 cell cycle arrest biomarkers in cases diagnosed with (PRAKI) as a diagnostic tool and if they have a role in differentiating the different causes of PRAKI
Summary
Pregnancy-related acute kidney injury (PRAKI) is still a common issue in developing countries with serious consequences on the mother and fetus [1]. PRAKI occurs mainly during the third trimester and postpartum period. The etiology of PRAKI is highly variable depending on the country and trimester of pregnancy. Hypertensive complications of pregnancy, namely pre-eclampsia and eclampsia, are the leading cause of PRAKI in both developed and developing countries. Pregnancy-related acute kidney injury (PRAKI) is still a common serious problem in developing countries. At a cutoff 0.33 ng/ml, the estimated sensitivity and specificity of urinary [TIMP-2]*[IGFBP7] in predicting PRAKI is 100% (95% CI) with NPV and PPV are 100%. Conclusion: Urinary [TIMP-2]*[IGFBP7] serves as a sensitive and specific biomarker in the diagnosis of PRAKI
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