Pregnancy Related Acute Kidney Injury: A Single Tertiary Care Center Experience

Objective: To describe an Egyptian single tertiary care center experience regarding the incidence, etiology and maternal and
perinatal outcomes of pregnancy-related acute kidney injury (PR-AKI).
Materials and Methods: This was a retrospective analysis of prospectively collected data of women with AKI admitted
to Mansoura University Hospital (MUH) during pregnancy or two weeks postpartum for a pregnancy- or delivery-related
cause. All patients were followed up for 3 months from the time of AKI diagnosis in order to assess the maternal outcome
(recovery, non-recovery or mortality). Patients who did not require dialysis were compared with those who required
dialysis.
Results: Over the 1.5-year study period, 18 patients with PR-AKI were admitted to MUH, representing a cumulative
incidence of 4.1 per 1000 deliveries. Out of these patients, 10 patients (55.6%) required dialysis while the other 8 patients
(44.4%) did not require dialysis. The commonest cause of AKI was severe preeclampsia (50%) and other causes included
AFLP (16.7%), hemorrhage (16.7%) and sepsis (16.7%). Thirteen cases (72.2%) had complete recovery of kidney function
while 2 cases (11.1%) did not have complete recovery after the 3-months follow up period. Maternal mortality occurred
in 3 cases (16.7%) who had sepsis and hemorrhage.
Conclusion: Preeclampsia, represent the commonest cause of PR-AKI, and although it has a favorable maternal outcome,
the perinatal outcome is very poor. Obstetric hemorrhage had not become the leading cause of PR-AKI, but delayed
referral of cases with severe peripartum bleeding, especially when associated with sepsis, is responsible for most of the
maternal mortalities.