Incidence of Pregnancy-Related Acute Kidney Injury in a Low Resource Setting: A Prospective Study https://doi.org/10.60787/NMJ-64-5-361

Main Article Content

Ejiro Praise Orhewere
Ogochukwu Chinedum Okoye
Oluseyi Ademola Adejumo

Keywords

Pregnancy, Related Acute Kidney Injury, Aetiology, Peripartum

Abstract

Background: Pregnancy-related acute kidney injury (PRAKI) is a common cause of AKI globally. The incidence and burden of PRAKI are still high in low and middle-income countries (LMICs) especially in Africa due to limited access to optimal obstetric care, late diagnosis, and referral. The study aimed to determine the incidence and aetiologies of PRAKI among women in the peripartum period in two government hospitals in Nigeria.


Methodology: This was a prospective study where serum creatinine was measured among pregnant women presenting in labour at 0 hours, 6 hours, 12 hours, 24 hours, 48hour and 7 days post-delivery. AKI was defined using the Kidney Disease Improving Global Outcome criteria. Binary logistic regression was used to determine predictors of PRAKI.


Results: The mean age of the 162 pregnant women who completed the study was 30.05±1.28 years. The incidence of AKI use was 22.2%. The aetiologies of PRAKI were obstetric haemorrhage (66.7%), eclampsia (19.4%), and sepsis (13.9%). Seventeen (47.2%) patients had Stage 1 PRAKI, 12 (33.3%) had Stage 2 PRAKI, while seven (19.4%) had Stage 3 PRAKI. Factors significantly associated with PRAKI were parity (p=<0.001), caesarean section (p=<0.001), excess blood loss (p=<0.001), and prolonged duration of labour (p=0.002).


Conclusion: PRAKI occurred in 1 out 5 pregnant women in the peripartum period. Obstetric haemorrhage, sepsis, and eclampsia which are preventable or treatable are common major aetiologies of PRAKI. PRAKI is more associated with multi-parity, caesarean delivery, haemorrhage, and prolonged duration of labour. Optimal ante-natal care, health education, and prompt diagnosis and management of obstetric complications will reduce the incidence in Nigeria.

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References

1. Trakarnvanich T, Ngamvichchukorn T, Susantitaphong P. Incidence of acute kidney injury during pregnancy and its prognostic value for adverse clinical outcomes: A systematic review and meta-analysis. Medicine (Baltimore). 2022;101(30):e29563

2. Shalaby AS, Shemies RS. Pregnancy-related acute kidney injury in the African continent: where do we stand? A systematic review. J Nephrol 2022:1-15

3. Vinturache A, Popoola J, Watt-Coote I. The Changing Landscape of Acute Kidney Injury in Pregnancy from an Obstetrics Perspective. J Clin Med. 2019;8(9):1396.

4. Rao S, Jim B. Acute kidney injury in pregnancy: the changing landscape for the 21st century. Kid Int Reports. 2018;3(2):247-57.

5. Davidson B, Bajpai D, Shah S, Jones E, Okyere P, Wearne N et al. Pregnancy-Associated Acute Kidney Injury in Low-Resource Settings: Progress Over the Last Decade. Semin Nephrol. 2022 ;42(5):151317.

6. Bantewad D, Yadia M. WCN23-0758 Pregnancy-related acute kidney injury-an 8-year study from South India. Kid Int Reports. 2023;8(3):S96-7.

7. Sachan R, Shukla S, Shyam R, Sachan PL, Patel ML. Feto-maternal outcome of pregnancy-related acute kidney injury in a North Indian population. J Family Community Med. 2022;29(3):204-211.

8. Sivakumar V, Sivaramakrishna G, Sainaresh V V, Sriramnaveen P, Kishore C K, Rani CS et al. Pregnancy-related acute renal failure: A ten-year experience. Saudi J Kidney Dis Transplant. 2011;22:352–3.

9. Cochran WG. Sampling Techniques third edition. In: Sampling Techniques 3rd ed. John Wiley & Sons. New York City;2004. 89–94

10. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice. 2012;120(4):179-84.

11. Teles F, Teixeira ME, de Almeida LL, Lins CR, Santos RO, Costa AF. Impact of a Timely Nephrologic Consultation in Acute Kidney Injury in a Public Hospital. J Clin Nephrol Res. 2016;3:1035-41.

12. Stubblefield PG, Grimes DA. Septic abortion. New England Journal of Medicine. 1994;331(5):310-4.

13. Gupte S, Wagh G. Preeclampsia–Eclampsia. J Obs Gynaecol India 2014;64(1):4–13.

14. Royal College of Obstetrics and Gynaecology (RCOG). Antepartum Haemorrhage. Green-top Guideline No 63. London: Royal College of Obstetricians and Gynaecologists. 2011.available at: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/antepartum-haemorrhage-green-top-guideline-no-63/. Accessed 10th June 2023.

15. Anderson JM, Etches D. Prevention and Management of Postpartum Hemorrhage - American Family Physician. Am Fam Physician 2007;75(6):875–82.

16. van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis. 2010;23(3):249-54.

17. Cooke WR, Hemmilä UK, Craik AL, Mandula CJ, Mvula P, Msusa A et al. Incidence, aetiology and outcomes of obstetric-related acute kidney injury in Malawi: a prospective observational study. BMC Nephrol. 2018;19(1):25.

18. Ruggajo PJ, Appollo EO, Bramania PK, Basil TB, Furia FF, Mngumi JW. Prevalence, Risk Factors and Short-term Outcomes of Acute Kidney Injury in Women with Obstetric Complications in Dar es Salaam, Tanzania. Tanzania Medical Journal 2022;33(3):14-29

19. Arrayhani M, El Youbi R, Sqalli T. Pregnancy-related acute kidney injury: experience of the nephrology unit at the University Hospital of Fez, morocco. ISRN Nephrol. 2012;2013:109034

20. Adejumo OA, Akinbodewa AA, Enikuomehin OC, Lawal OM, Abolarin OS, Alli OE. Pregnancy-related acute kidney injury: Etiologies and short-term outcomes in a tertiary hospital in Southwest Nigeria. Saudi J Kidney Dis Transpl. 2019;30(6):1423-1430.

21. Rage HI, Kumar Jha P, Hashi HA, Abdillahi NI. Pregnancy-Related AKI: A Tertiary Care Hospital Experience in Somaliland. Kidney Int Rep. 2023;8(3):388-391

22. Aminu MS, Muhamad U, Garba BI, Abdullahi U, Mohammed B A, Garba S et al. 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. Tropical J Nephrol 2017;12(2):17–20.

23. Hounkpatin HO, Fraser SD, Johnson MJ, Harris S, Uniacke M, Roderick PJ. The association of socioeconomic status with incidence and outcomes of acute kidney injury. Clinical Kidney Journal. 2020;13(2):245-52.

24. Nwosu CO, Ataguba JE. Socioeconomic inequalities in maternal health service utilisation: a case of antenatal care in Nigeria using a decomposition approach. BMC Public Health. 2019;19(1):1-1.

25. Pandey S, Karki S. Socio-economic and Demographic Determinants of Antenatal Care Services Utilization in Central Nepal. Int J MCH AIDS. 2014;2(2):212-9

26. Makusidi AM, Liman HM, Yakubu A, Hassan M, Isah MD, Chijioke A. Hemodialysis among pregnancy-related acute kidney injury patients: A single centre experience in North-Western Nigeria. Indian J Nephrol 2016;26(5):340–2.

27. Yadav S, Chauhan M, Jain D, Aggarwal HK, Yadav RK. Renal Outcomes of Pregnancy-Related Acute Kidney Injury: a Single Centre Experience in India. Maedica (Bucur). 2022;17(1):80-87.

28. Eswarappa M, Madhyastha PR, Puri S, Varma V, Bhandari A, Chennabassappa G. Postpartum acute kidney injury: a review of 99 cases. Renal failure. 2016;38(6):889-93.

29. Alsammani MA, Jafer AM, Khieri SA, Ali AO, Shaaeldin MA. Effect of grand multiparity on pregnancy outcomes in women under 35 years of age: a comparative study. Medical Archives. 2019;73(2):92.

30. Dasa TT, Okunlola MA, Dessie Y. Effect of grand multiparity on adverse maternal outcomes: A prospective cohort study. Front Public Health 2022; 10:959633.

31. Gedefaw G, Demis A, Alemnew B, Wondmieneh A, Getie A, Waltengus F. Prevalence, indications, and outcomes of caesarean section deliveries in Ethiopia: a systematic review and meta-analysis. Patient Saf Surg. 2020;14:11

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