Pregnancy Related Acute Kidney Injury, Clinical profile and Outcome of management: an experience from 3 years retrospective review in a specialist hospital in Gusau, North-Western Nigeria.

Abstract

Introduction: Pregnancy related acute kidney injury (PRAKI) is a clinical syndrome characterised by a rapid decline in glomerular filteration rate occuring during pregnancy or puerperium. It is associated with high morbidity and mortality. We investigated the clinical presentation, management and outcome of PRAKI in our hospital.

Methods: A retrospective review of all women admitted into Ahmad Sani Yariman Bakura Specialist Hospital with PRAKI from June 2013 to May 2016 was conducted with emphasis on clinical profile, management and outcome.

Results: Over the period of 3 years, 26 women with PRAKI were found with age ranging from 17 to 35 years, 12(46%) were from obstetrics haemorrhage; 4(15.4%) puerperal sepsis; 6(23.1%) preeclampsia/eclampsia; 2(7.7%) acute pyelonephritis and 2(7.7%) from hyperemesis gravidarum. Most of the cases 20(77%) occurred in third trimester and puerperium, 4(15.3%) in first trimester and 2(7.7%) in second trimester. The mean serum urea and creatinine at presentation were 27.5mmol/L and 463umol/L respectively.

Seven patients had dialysis (26.9%) out of which 4(15.4%) had complete recovery, 2 (7.6%) died and 1(3.8%) was dialysis dependent. The indications for dialysis were persistent oliguria/anuria in 3(43%), pulmonary oedema with severe metabolic acidosis in 2(28.5%) and uraemic encephalopathy in 2(28.5%). Number of sessions ranged from 3 to 6.

The remaining 19 cases (73%) were managed conservatively with complete recovery in 13(68.4%) and mortality in 6(31.6%). The maternal mortality of 30.8% from PRAKI was observed.

Conclusion: PRAKI remains an important cause of maternal morbidity and mortality in our environment. There is need to improve our obstetric care to prevent this menace.