Pregnancy Related Acute Kidney Injury: An Exigent Cause of Chronic Kidney Disease in Developing Countries

Background: Development of PRAKI due to various gestation-related complication leads to poor maternal and foetal outcome. The aim of this study was to estimate the prevalence of PRAKI resulting in CKD, associated factors and feto-maternal outcome.

Methods: In this prospective observational study patients with PRAKI requiring ≥ 1 session of haemodialysis were included and followed up for 6 months to assess renal outcomes.

Results: During study period of 2 years, out of total AKI patients 8.5% patients presented with PRAKI requiring ≥ 1 session of dialysis. Most common time of presentation within first week of delivery in 62.9% of patients. Sepsis was the most prevalent etiology responsible for PRAKI in 40.3%. Diffuse renal cortical necrosis was the most common histopathological finding in 42.4% of patients. At 3 months of follow-up, patients with sepsis and sepsis with PPH showed poor renal recovery. Overall 38.2% patients completely recovered, while 61.8% showed partial or no recovery in renal function at 3 months. At the end of 6 months total maternal mortality was 14.5% and 3 patients lost to follow-up. Out of 50 patients 38% completely recovered, 30% showed partial recovery without need of dialysis and 32% patient developed ESRD and remain on maintenance haemodialysis.

Conclusion: PRAKI can severely effect the short- and long-term renal outcomes and it can be considered as an exigent cause of CKD with grave prognosis. Regular antenatal care, promotion of institutional delivery and early identification of factors responsible for PRAKI can reduce feto-maternal mortality and morbidity.