Diagnosis Of Pregnancy-related Acute Kidney Injury Research Articles

Value of the cell cycle arrest biomarkers in the diagnosis of pregnancy-related acute kidney injury.

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.

Frequency of pregnancy-related complications causing acute kidney injury in pregnant patients at a tertiary care hospital

Acute kidney injury (AKI) in pregnancy is associated with significant maternal morbidity and mortality. Several studies from worldwide have shown different frequencies of the causes of pregnancy-related AKI (PRAKI). The present study aimed to provide local data on frequency of causes of PRAKI. A total of 111 pregnant women using nonprobability consecutive sampling technique, with the age group of 18-45 years, admitted with the diagnosis of PRAKI were included in the study. The information regarding age, duration of pregnancies, serum creatinine levels, and outcome variables (complications) were collected from each patient. Effect modifiers were controlled by stratification. The mean age was 29.90 ± 5.40 years. Out of 111 cases, 10 (9%) developed AKI in the 1st trimester, 12 (10.8%) in the 2nd trimester, 13 (11.7%) cases in the 3rd trimester, and rest of the 76 (68.4%) cases were of the postpartum period. The etiology of PRAKI was multifactorial in several patients. The frequencies of complication leading to AKI were observed individually. The results showed that 21 (18.9%) had antepartum hemorrhage, 41 (36.9%) postpartum hemorrhage, 33 (29.7%) puerperal sepsis, 11 (9.9%) preeclampsia, 13 (11.7%) eclampsia, 11 (9.9%) hemolysis, elevated liver enzymes, and low-platelet count syndrome, 7 (6.3%) hemolytic uremic syndrome, and 5 (4.5%) had hyperemesis gravidarum. The results of the present study showed no statistically significant association of age with the individual complications with P >0.05. AKI during pregnancy was mostly due to prerenal causes. The most common cause was postpartum hemorrhage followed by puerperal sepsis and antepartum hemorrhage.

Acute kidney injury in pregnancy

Abstract Pregnancy-related acute kidney injury (P-AKI) incidence has reduced over the recent years with better accessibility and advances in health care. It is still a concern in developing countries where septic abortions and puerperal sepsis persist due to lack of health facilities. Recent advances have helped in a better understanding of pathogenesis of disorders like pre-eclampsia, acute fatty liver of pregnancy, and thrombotic microangiopathy which has helped the physicians to solve the enigma in both diagnosis and management of these conditions. Diagnosis of P-AKI is challenging due to normal maternal physiological changes. Usual definitions of AKI are not very accurate in pregnancy and newer markers for diagnosis of AKI are not well studied in pregnancy. Early identification of the cause of P-AKI and its prompt treatment holds the key in the management of P-AKI. It is of utmost importance to maintain the hemodynamics and acid base balance for ensuring proper utero-placental blood flow and fetal well being in P-AKI. There is neither particular modality of RRT which is better than other nor a preset dialysis prescription for P-AKI, and renal replacement therapy should be individualized to provide optimal care.