Obstetric Acute Kidney Injury Research Articles

Postpartum Renal Cortical Necrosis: A Case Series

Rationale & ObjectivePostpartum renal cortical necrosis (postpartum RCN) is a severe form of obstetric acute kidney injury. This study aimed to identify clinicopathological features in Chinese postpartum RCN cases to determine how pathologic findings may contribute to the treatment and prognosis. Study DesignSingle-center, case series Setting & ParticipantsTwelve patients with postpartum RCN had kidney biopsies at Peking University First Hospital between 2014 and 2021. The diagnosis of postpartum RCN was made according to typical MRI or pathological features. Clinical, laboratory and pathological data were compared between patients with eGFR <30 (poor outcome) and ≥30 ml/min/1.73 m2 after six months. ObservationsAll postpartum RCN patients presented with stage 3 AKI attributed to a probable atypical hemolytic uremic syndrome. Pregnancy terminations occurred at a median gestational age of 35.5 weeks. Kidney biopsy was performed ranging 18 days to 4 months from delivery. Upon biopsy, hemoglobin, platelet count and LDH levels had been restored to 137 g/L, 214 ×109/L and 231.50±65.01 U/L, respectively. Four patients exhibited poor outcome, demonstrating higher schistocyte count, serum creatinine and mean arterial pressure at onset. Pathologically, glomerular segmental sclerosis was prevalent. The NOS variant was the most common type, followed by collapsing variant, cellular variant, and tip variant. Patients with poor kidney outcome had more glomerular coagulative necrosis, capillary thrombosis, extensive cortical coagulative necrosis, and pronounced arteriole/artery lesions including increased interlobular arteriole intimal edema and fibrin thrombosis, but a lower occurrence of segmental sclerosis. LimitationsLimited sample size and retrospective design. ConclusionsOur research has identified key pathological features in postpartum RCN patients with aHUS, highlighting the necessity for more effective therapeutic options. There is a clear demand for non-invasive biomarkers that can accurately track disease progression and inform treatment duration for long-term outcomes improvement.

#4767 ACUTE CORTICAL NECROSIS IN PREGNANCY IS STILL AN IMPORTANT CAUSE FOR END-STAGE RENAL DISEASE IN DEVELOPING COUNTRIES

Abstract Background and Aims Renal cortical necrosis (RCN) is a serious complication of acute kidney injury (AKI) and pregnancy is a clinical state closely associated with it with poor renal outcomes. The incidence is much higher in obstetrical AKI compared to other causes of RCN. Despite better medical care facilities available, this continues to be an important cause of morbidity and mortality in developing countries. Method This is a retrospective analysis among all pregnant females presenting with AKI from January 2000 to December 2020 at a tertiary care center in the northern part of India. We looked for the incidence of obstetrical-related RCN in our renal biopsies performed in the last 20 years and to evaluate precipitating factors responsible for RCN. Results RCN constituted 8.1 % of pregnancy-related AKI cases in our institution. The overall incidence has been declining which was 9.09% from 2000 to 2008 to 8.7 % from 2009 to 2014 and 8.1% from 2014-2020. The patient's median age was 28.4 ± 4.6 years. The average time to presentation from the day of delivery was 7.8 ±3.0 days. The mortality was observed in 10.4 % of them with sepsis and multiorgan dysfunction present in all of them. The most common etiology for RCN was found to be septic abortion and puerperal sepsis accounting for - 16.2 % each. Postpartum hemorrhage was a cause in 9.67 % of patients. The most important cause of RCN was postpartum thrombotic microangiopathy which was observed in 49.5% of patients. Kidney biopsy was helpful in diagnosis in 36 patients while computed tomography scan abdomen alone helped in diagnosis in five patients. Patchy cortical necrosis in histology was seen in 36.7% of patients and morbidity in terms of prolonged hospitalization was seen in 23.4 % while dialysis dependency in 63.4% of the study population Conclusion Strategies need to be implemented in reducing the preventable causes for RCN which is not only catastrophic in terms of renal outcomes but also for social and psychological perspectives as well.

Acute Kidney Injury Due to Obstetric Complications.

To evaluate the factors, causes, and outcomes of acute kidney injury (AKI) among pregnant females admitted to a tertiary care hospital. An observational study. Place and Duration of the Study: Department of Nephrology, Liaquat University Hospital, Hyderabad, from April to October 2022. Patients with AKI due to obstetric complications were enrolled and followed for three months. AKI was defined as a rise in serum creatinine of 0.3 mg/dl within 48 hours, an increase in serum creatinine of 1.5 times baseline value within the previous 7 days, or a decrease in urine output of 0.5 ml/kg/hr for 6 hours. Good antenatal care was defined as at least one visit to a healthcare provider during pregnancy. Patients with the history of diabetes or hypertension, chronic kidney disease or history of renal stones were excluded from the study. Favourable outcomes such as complete recovery were assessed at the time of discharge in terms of renal function testing. Patients who had normal renal function, adequate urine output, and became dialysis independent were labelled as completely recovered. Unfavourable outcomes were assessed in terms of progress towards either chronic kidney disease or death. Of the initially enrolled 66 patients, 6 were lost to follow-up and 60 patients were included in the final analysis. The mean age was 28.67±5.41 years. Only 2 patients had received good antenatal care (3.3%). Puerperal sepsis was the primary aaetiology of AKI in 20 patients (33.3%), antepartum haemorrhage in 14 patients (23.3%), and postpartum haemorrhage in 16 (26.7%) patients. In eight cases, there was combined haemorrhage and sepsis. Other causes of AKI were pre-eclampsia and placentae abruption. Nine of 60 patients were treated conservatively, while 51(85%) were treated with dialysis. Five patients died (8.3%), fifteen recovered (25%), and 40(66.7%) patients who needed dialysis at the time of discharge acquired chronic renal disease throughout the three-month follow-up period. An overwhelming majority of obstetric-related AKI patients had a suboptimal antenatal care history. The most frequent aetiology was puerperal sepsis, followed by haemorrhage. Majority of the patients with required hemodialysis and most of them did not recover in three months resulting in dialysis-dependent chronic kidney disease. Acute kidney injury, Obstetric acute kidney injury, Pregnancy, Obstetric complications, Antenatal care, Haemorrhage, Puerperal sepsis.

Acute kidney injury in obstetrics: Hospital-based cohort study.

Obstetric acute kidney injury (AKI) is a serious unsolved global health-care problem and is a significant contributor to the overall burden of AKI resulting in devastating maternal and foetal outcomes. We studied the characteristics of obstetric AKI and the factors related to its unfavourable outcome. A total of 110 patients developed AKI among 10,138 admission giving a frequency of 1.08%. The commonest risk factor was pre-eclampsia followed by haemorrhage and sepsis. Complete recovery of renal function occurred in 40.9%. However, 9.1% were left with end-stage renal disease. AKI due to sepsis, delayed referral and deranged renal function on admission was associated with unfavourable outcome. AKI in pregnancy merits special attention because it involves risk to two lives, mother and foetus. Early identification of risk factors coupled with timely and efficient management will result in reducing obstetric AKI and associated maternal morbidity and mortality.

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

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 &lt;60ml/min/1.73m2. Duration of oligoanuria was the only predictor of eGFR&lt;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. ...................

POS-044 EPIDEMIOLOGICAL TRENDS IN COMMUNITY ACQUIRED ACUTE KIDNEY INJURY IN PAKISTAN: 25 YEARS EXPERIENCE FROM A TERTIARY CARE RENAL UNIT

Epidemiological studies of acute kidney injury (AKI) are sparse especially from South Asia. Reported incidences vary with use of different criteria of defining AKI. There is also variation found in different class of income countries, hospital based versus community based AKI. Within hospital based there could be variations in critically ill patients, patients with major surgeries or trauma, association of sepsis and hospital admissions for other reasons. The current study carried out in all adult AKI patients developing community acquired AKI and coming to a tertiary care renal institution in Pakistan from January 1990 to Dec 2014. This is a retrospective data collection from patient’s records and AKI was defined according to KDIGO guidelines. Trends among different groups which are classified in medical, obstetrical and surgical were recorded. The study protocol was in accordance with the Declaration of Helsinki and SIUT’s Institutional Ethical Review Committee has granted permission for collection and presentation of this data. During study period of 25 years; A total of 5,623 patients were diagnosed to have AKI. Patients categorized in Medical, Obstetrical and Surgical causes for AKI. Medical causes contributed 60 %, obstetrical 26% and rest were surgical. Mean age was 35.91± 15.81, 27.83 ±5.66 and 43.24± 16.74 respectively in these groups. In medical AKI there has been found a rise in toxic rhabdomyolysis, vivax malaria and dengue infection during later part of study (table). In obstetrical AKI observed continuous rise in numbers contributing to total AKI during these years. Surgical AKI included obstructed cases during initial ten years and only surgical trauma during later 15 years. The overall requirement for renal replacement therapy was 82 percent, indicating the severity of kidney injury on arrival. Older age on presentation in medical AKI, and thrombocytopenia , deranged coagulation, deranged liver function, hyperkalemia, requirement of mechanical ventilation and multi organ failure in all groups remained predictors of higher mortality. TableMedical AKICAUSESGroup I (1990-1999)Group II (2000 – 2004)Group III (2005 – 2009Group IV (2010 – 2014)Total 25 years (n=3,389)Acute GE302190183178853Malaria21493203251671Rhabdomyolysis673552180334Acute GN/ Vasculitis88323680236Sepsis71312832162Nephrotoxic Drugs74242433155Snake Bite38163031115Poisons138111547Hemolytic Uremic Syndrome18861345Dengue0293243Hepato Renal Syndrome8231427Acute Pancreatitis634619Scorpion Sting1241118Misc. Causes887292105357Unknown Causes42535589239 Open table in a new tab From Pakistan epidemiology for community acquired AKI has never been published on a large scale and this study would remain source of great information in this regard over coming years.

Obstetrical Acute Kidney Injury: Epidemiology and Clinical Aspects in Teaching Hospital of Ignace Deen, Conakry Guinea

Introduction: In Guinea, data on the acute kidney injury (AKI) of women in the obstetrical context is still limited. This study attempted to determine the prevalence and the clinical signs of obstetric AKI in Guinea. Patients and methods: The study population consisted of pregnant or postpartum women with AKI, whom we treated in this institute from August 2018 to January 2019. All had normal anterior renal function with serum creatinine clearance ≥ 120 μmol/L, and then suffered AKI. Patients characteristics were examined; maternal age, gestational weeks, AKI characteristics. Results: Of 2438 pregnant women admitted during the study period, 56 showed AKI. Antepartum and postpartum AKI accounted for approximately 80% and 17%, respectively. Regarding the maternal age, <25 years of age accounted for 54% (range: 17 - 40). Multiple gestations accounted for 34 (60.71%) of which functional AKI, organic AKI, and obstructive AKI accounted for 28/34, 2/34, and 4/34, respectively. Regarding the clinical manifestations, abdominal pain, tinnitus, visual disturbances, edema of the lower limb, and facial swelling accounted for 79%, 75%, 7%, 57%, and 54%, respectively. Conclusion: We here demonstrated peripartum AKI in Guinea, which findings may provide fundamental data to establish some strategy against this condition in this region.

Acute cortical necrosis in pregnancy still an important cause for end-stage renal disease in developing countries.

Renal cortical necrosis (RCN) is a serious complication of acute kidney injury (AKI) and pregnancy is a clinical state closely associated with it with poor renal outcomes. The incidence is much higher in obstetrical AKI compared to other causes of RCN. Despite better medical care facilities available, this continues to be an important cause of morbidity and mortality in developing countries. This is a retrospective analysis among all pregnant females presenting with AKI from January 1999 to December 2014 at a tertiary care center in the northern part of India. We looked for the incidence of obstetrical-related RCN in our renal biopsies performed in the last 15 years and to evaluate precipitating factors responsible for RCN. RCN constituted 8.3% of pregnancy-related AKI cases in our institution. The overall incidence has been declining which was 9.09% from 1999 to 2008 to 7.8% from 2009 to 2014. The patient's median age was 29.3 ± 5.2 years. The average time to presentation from the day of delivery was 8.7 ±2.1 days. The mortality was observed in 11.7% of them with sepsis and multiorgan dysfunction present in all of them. The most common etiology for RCN was found to be septic abortion and puerperal sepsis accounting for - 15.3% each. Postpartum hemorrhage was a cause in 9.09% of patients. The most important cause of RCN was postpartum thrombotic microangiopathy which was observed in 48.7% of patients. Kidney biopsy was helpful in diagnosis in 31 patients while computed tomography scan abdomen alone helped in diagnosis in five patients. Patchy cortical necrosis in histology was seen in 35.4% of patients and morbidity in terms of prolonged hospitalization was seen in 22.7% while dialysis dependency in 61.5% of the study population. In conclusion, strategies need to be implemented in reducing the preventable causes for RCN which is not only catastrophic in terms of renal outcomes but also for social and psychological perspectives as well.

Characteristics and Outcome of Obstetric Acute Kidney Injury in Pakistan: A Single-center Prospective Observational Study.

IntroductionAcute kidney injury (AKI) continues to be a cause of increased morbidity and mortality in pregnant women. While studies have been conducted on the incidence and etiology of this complication, the outcomes of obstetric AKI have not been extensively investigated. The primary focus of this prospective observational study was to analyze the risk factors, etiologies as well as maternal and fetal outcomes of AKI in pregnant females in Pakistan.MethodsA total of 56 patients with obstetric AKI were recruited. Patients were followed for a period of three months postpartum. The diagnosis and staging of AKI were based on the classification of the Acute Kidney Injury Network (AKIN).ResultsFifteen patients were lost to follow-up and were excluded from the study. The mean age of the remaining 41 patients was 26±6 years. Twenty-two (54%) patients were multigravida, and 19 (46%) were primigravida. Twenty (48%) patients did not receive any antenatal care, 13 (31%) were visited by a traditional birth attendant, and only eight (19%) had adequate antenatal care by a gynecologist. Out of 41 patients, seven (17%) presented before 28 weeks, and 34 (83%) patients presented after 28 weeks of gestation. Four (10%) patients were found to be in stage I, four (10%) in stage II, and 33 (80%) patients in stage III AKI during hospitalization. The causes of AKI included sepsis in 32 (78%), intrauterine death in 24 (60%), postpartum hemorrhage in 17 (41%), shock in 15 (36%), pre-eclampsia/eclampsia in seven (17%), and coagulopathy in three (7%) patients. Twenty-eight (68.3%) patients received hemodialysis during the hospital stay. Three-month follow-up showed complete resolution of AKI in 14 (34.2%) patients, partial resolution in seven (17%), end-stage renal disease in 10 (24.4%), and death in 10 (24.4%) patients.ConclusionThe present study indicates that a vast majority of patients with obstetric AKI require dialysis. Residual renal dysfunction and end-stage renal disease were common at the three-month follow-up. Incidentally, sepsis and intrauterine death were the leading causes in this study population. Increased awareness and appropriate obstetrical care may have a significantly positive impact on decreasing the morbidity and mortality in these patients.

The Clinical Pattern and Outcomes of Acute Kidney Injury in a Semi-Urban Hospital Setting in Cameroon

Background: Acute kidney injury (AKI) is a common disorder with high morbi-mortality especially in developing countries. In contrast to high income regions, AKI in these areas tend to be more community-acquired and affect young people. As in most Subsahara countries, previous studies on AKI in Cameroon were carried out in urban tertiary hospitals. Data on the clinical pattern and outcomes in semi-urban is lacking and may be quite different of urban setting. Objective: To describe the clinical pattern and outcomes of AKI in Buea Regional Hospital. Methods: We conducted an 18 months’ hospital-based observational retrospective study in the regional hospital of Buea, a semi-urban second category health facility of the South-West region of Cameroon. We excluded patients with known CKD (Chronic Kidney Disease)and incomplete data. AKI was diagnosed and classify according to the 2012 KDIGO criteria. Renal outcome was evaluated at 1 month. Results: Of the 196 participants included, 57.7% were males and 10.7% children. The median age was 45 years. HIV infection, hypertension and diabetes were the main comorbidities. AKI was community-acquired in 95% and stage 3 was found in 59%. Sepsis (37.2%), volume depletion (25%) and nephrotoxicity from herbal remedies (15.3%) were the main etiologic factors. Renal AKI was found in 72% of patient and was mostly due to ATN (56.6%). Obstetrical AKI was mainly due to post-abortum sepsis and AKI related malaria were the main etiology of pediatric AKI. In all, 71 (36%) participants had indications for dialysis but only 52 (73%) accessed it. Lack of appropriate dialysis technique and lack of funds were the main reasons for dialysis non-access. In-hospital mortality was 37.2%. Among survivors, renal recovery was complete in 65%, partial in 21%, and no recovery in 3%. Stage 3 disease was the only predictor of poor renal recovery at one month. Conclusion: AKI in this semi-urban hospital setting is community acquired and affected young individual with previous comorbidities such as HIV/AID, hypertension and diabetes. It is mainly caused by infections, volume depletion and herbal toxins.

Obstetric acute kidney injury: A retrospective study

Obstetric acute kidney injury: A retrospective study

Renal Support for Acute Kidney Injury in the Developing World

There is wide variation in the management of acute kidney injury (AKI) and the practice of renal replacement therapy (RRT) around the world. Clinicians in developing countries face additional challenges due to limited resources, reduced availability of trained staff and equipment, cultural and socioeconomic aspects, and administrative and governmental barriers. In this article, we report the consensus recommendations from the 18th Acute Dialysis Quality Initiative conference in Hyderabad, India. We provide the minimal requirements for provision of acute RRT in developing countries, including patient selection, choice of RRT modality and monitoring, transition, and termination of acute RRT. We also discuss areas of uncertainty and propose themes for future research. These recommendations can serve as a foundation for clinicians to implement renal support for AKI in low resource settings.

A Single-Centre Experience of Obstetric Acute Kidney Injury.

Acute kidney injury (AKI) is a clinical syndrome characterized by a sudden decline in glomerular filtration rate leading to decreased excretion of nitrogenous waste products. It continues to be a common problem in developing countries. The aim of this study was to understand AKI characteristics in pregnancy and identify the factors related to its unfavorable outcome. A prospective cross-sectional study. This prospective study was conducted between January 2013 and May 2014. In total 570 women with AKI were referred to the Kidney Institute during this period, out of which 52 patients with obstetrics AKI were included in this study. Incidence of obstetric AKI was 9.12%. Their age varied from 19 to 34years, with an average of 26.2years. About 42(80.8%) patients had not received antenatal care. The main causes of AKI were obstetric hemorrhage (38.46%) and puerperal sepsis (15.38%). The outcome was favorable with complete renal function recovery in 55.76% patients. Four (7.69%) patients became dialysis dependent. Maternal mortality was 32.69%. Obstetric AKI is a critical situation in developing countries. Lack of antenatal care (80.8%) is a major contributing factor for obstetric-related complications leading to renal failure. Obstetric hemorrhage (38.46%) is the most common cause of obstetric AKI. Late referral in 18 (34.61%), puerperal sepsis in six (33.33%), obstetric hemorrhage in five (27.77%) and combined sepsis and hemorrhage in five (27.77%) are the common contributing factors leading to its unfavorable outcomes as maternal morbidity and mortality. Hence, a multidisciplinary approach is warranted to prevent such an avoidable complication.

Renal cortical necrosis is a disappearing entity in obstetric acute kidney injury in developing countries: our three decade of experience from India

Rational: Obstetrical complications are the commonest causes of Renal Cortical Necrosis (RCN). However, the overall incidence of RCN in obstetric acute kidney injury in developing countries has been decreasing in recent years. Objective: The aim of this study was to evaluate the changing profile of RCN in obstetric AKI over the last three decades. Methods: This single center study included patients with biopsy proven renal cortical necrosis over a period of 32 years from 1982 to 2014. The diagnosis of RCN was suspected in patients with prolonged AKI (>4 weeks) with absolute anuria in the setting of hemorrhage, hypotension and sepsis; and was confirmed by renal biopsy. The changing pattern in the incidence, etiology and outcome of RCN in patients with obstetric AKI was compared in the three study periods, namely 1982–1991, 1992–2002 and 2003–2014. Results: Over a period of 32 years, RCN was diagnosed in 15/259(5.8%) cases of obstetric AKI. Diffuse and patchy cortical necrosis were noted in 8(53.3%) and 7(46.7%) patients, respectively. RCN occurred in 17%(11/65), 2.4%(3/125) and 1.44%(1/69) patients in 1982–1991, 1992–2002 and 2003–2014, respectively. Septic abortion was commonest cause of RCN in the first two study periods but no case was observed in last decade. The decrease in incidence of RCN over the three decades was statistically significant (p-value < 0.001). Maternal mortality decreased to zero in 2003–2014 from 72.7% in 1982–1991. Conclusions: The incidence of RCN in obstetric AKI in developing countries has declined low enough to label it as a disappearing entity.

Changing picture of renal cortical necrosis in acute kidney injury in developing country.

Renal cortical necrosis (RCN) is characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. In addition, direct endothelial injury particularly in setting of sepsis, eclampsia, haemolytic uremic syndrome (HUS) and snake bite may lead to endovascular thrombosis with subsequent renal ischemia. Progression to end stage renal disease is a rule in diffuse cortical necrosis. It is a rare cause of acute kidney injury (AKI) in developed countries with frequency of 1.9%-2% of all patients with AKI. In contrast, RCN incidence is higher in developing countries ranging between 6%-7% of all causes of AKI. Obstetric complications (septic abortion, puerperal sepsis, abruptio placentae, postpartum haemorrhage and eclampsia) are the main (60%-70%) causes of RCN in developing countries. The remaining 30%-40% cases of RCN are caused by non-obstetrical causes, mostly due to sepsis and HUS. The incidence of RCN ranges from 10% to 30% of all cases of obstetric AKI compared with only 5% in non-gravid patients. In the developed countries, RCN accounts for 2% of all cases of AKI in adults and more than 20% of AKI during the third trimester of pregnancy. The reported incidence of RCN in obstetrical AKI varies between 18%-42.8% in different Indian studies. However, the overall incidence of RCN in pregnancy related AKI has decreased from 20%-30% to 5% in the past two decades in India. Currently RCN accounts for 3% of all causes of AKI. The incidence of RCN in obstetrical AKI was 1.44% in our recent study. HUS is most common cause of RCN in non-obstetrical group, while puerperal sepsis is leading cause of RCN in obstetric group. Because of the catastrophic sequelae of RCN, its prevention and aggressive management should always be important for the better renal outcome and prognosis of the patients.

Obstetric acute kidney injury; a three year experience at a medical college hospital in north karnataka, India.

Acute kidney injury is a rare and sometimes fatal complication of pregnancy, the incidence of which has been declining worldwide, though still high in developing countries. There are recent observations of increasing incidence in some developed countries attributed to hypertensive disorders of pregnancy. In this study, we have analysed the records of all patients referred to the dialysis unit of a medical college hospital in Karnataka for acute kidney injury related to pregnancy. AKIN (Acute Kidney Injury Network) criteria for the diagnosis of acute kidney injury were adapted. Age, parity, gestational age, causative factors for acute kidney injury, mode of delivery, access to antenatal care, operative procedures, blood component transfusions, number of haemodialysis, time for initiation of haemodialysis, duration of hospital stay and mortality were analysed by finding mean, standard deviation and standard error. Fifteen patients out of 21563 who delivered in our hospital developed acute kidney injury. These (n=15) were out of 149 patients of acute kidney injury of various aetiologies who underwent haemodialysis between 2012 and 2014. Of these two were unregistered for antenatal care. Ten were multiparous, Eleven were from rural background, one had home delivery, six had vaginal delivery, seven had caesarean section and two had second trimester abortion. Placental abruption with intrauterine death was the commonest Cause in 9 out of 15 cases. All had severe anaemia. Patients received a mean of 3.9 (SD+/- 2.4) sessions of haemodialysis. Eleven patients recovered completely, two died and two left against medical advice. Obstetric acute kidney injury is associated with poor access to antenatal care, multiparity and rural background. Placental abruption is the commonest cause of obstetric acute kidney injury. Blood component transfusions, avoidance of nephrotoxic drugs and early initiation of haemodialysis are associated with better outcome.

Obstetrical Acute Kidney Injury: 25 Years’ Experience from Nephrology Care Unit in Pakistan

Objective: We aim to report observations from patients who developed acute kidney injury after complicated obstetrics and referred to our institution. Patients and Methods: Observational cohort of patients identified as having acute kidney injury (AKI) in ...

Changing epidemiology of community-acquired acute kidney injury in developing countries: analysis of 2405 cases in 26 years from eastern India.

BackgroundThe epidemiology of acute kidney injury (AKI) differs from country to country and varies from center to center within a country. Owing to the absence of a central registry, data on overall epidemiology of AKI are scanty from India.MethodsThis study aimed at describing changes in epidemiology of community-acquired AKI (CAAKI) over a time span of 26 years in two study periods, namely, 1983–95 and 1996–2008.ResultsWe studied 2405 (1375 male and 1030 female) cases of AKI in the age range 1–95 (mean: 40.32) years. The incidence of CAAKI in 1983–95 and 1996–2008 was 1.95 and 4.14 per 1000 admission, respectively (P < 0.01). Obstetrical AKI has decreased because of the declining number of post-abortal AKI. Surgical AKI decreased from 13.8% in 1983–95 to 9.17% in 1996–2008(P < 0.01). Malarial AKI increased significantly from 4.7% in the first half of the study to 17% in the later period (P < 0.01). Diarrhea-associated AKI had significantly decreased from 36.83% in 1983–95 to 19% in 1996–2008 (P < 0.01). Sepsis-related AKI had increased from 1.57% in 1983–95 to 11.43% in 1996–2008 (P < 0.01). Nephrotoxic AKI showed an increasing trend in recent years (P < 0.01) and mainly caused by rifampicin and NSAIDs. Liver disease-related AKI increased from 1.73% in 1983–95 to 3.17% in 1996–2008 (P < 0.01). Myeloma-associated acute renal failure (ARF) accounted for 1.25% of the total number of ARF cases in the period 1996–2008. HIV infection contributed to 1.65% of ARF of the total number of AKI cases in the second period (1996–2008). Incidence of renal cortical necrosis (RCN) decreased significantly from 5.8% in 1983–95 to 1.3% in 1996–2008 of the total number of ARF cases (P < 0.01). However, during the same period ARF due to acute tubular necrosis, acute glomerulonephritis and acute interstitial nephritis remained unchanged. The mortality rate from AKI decreased significantly from 20% in 1983–95 to 10.98% in 1996–2008 (P < 0.01).ConclusionsThe epidemiological characteristics of CAAKI have changed over the past three decades. There has been an increase in the overall incidence of ARF with the changing etiology of AKI in recent years. Incidences of obstetrical, surgical and diarrheal AKI have decreased significantly, whereas those of AKI associated with malaria, sepsis, nephrotoxic drugs and liver disease have increased. RCN has decreased significantly. In contrast to developed nations, community-acquired AKI is more common in developing countries. It often affects younger individuals and is caused by single and preventable diseases.