STUDY OF ACUTE KIDNEY INJURY IN POSTPARTUM FEMALES AT TERTIARY HEALTH CARE CENTER WITH SPECIAL REFERENCE TO FETAL AND MATERNAL OUTCOME.

Abstract

INTRODUCTION: Acute kidney injury is defined by a rise from baseline of at least 0.3mg/dl within 48 hr or at least 50% higher than baseline within 1 week or a reduction in urine output less than 0.5ml/kg per hr longer than 6 hr. Postpartum acute kidney injury constitutes an important cause of obstetric AKI. There are also however, pregnancy complications characteristics of each trimester that can be associated with AKI. AKI is associated with high foetal & maternal mortality in developing nations. Pregnancy-related
kidney injury (PRAKI) Is a major cause of maternal and foetal morbidity and mortality in developing countries. While sepsis and postpartum haemorrhage (PPH) are the major etiologic factors for PPAKI (Postpartum acute kidney injury) in developing countries, severe preeclampsia, PPH and HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome contribute to PPAKI in developed nations. AIMS AND OBJECTIVES: To study epidemiological factors, clinical progression and maternal/foetal outcome in pregnancy related kidney injury patients at Tertiary health care centre. MATERIALS AND
METHODOLOGY: A prospective, observational study was conducted of 25 postpartum females were admitted in sola civil hospital. A detailed history was taken including obstetric history and clinical profile on admission. Obstetric history included parity, history of
antenatal follow up, nature and place of delivery, maternal and foetal outcome. They were studied with respective to their history, clinical features, laboratory parameters, precipitating factors and renal outcome. DISCUSSION: The most common age group affected was 24-29 years with 64% patients were multigravida. Puerperal sepsis (56%) was the most common aetiology responsible for postpartum Acute kidney injury. Followed by postpartum haemorrhage, preeclampsia, HELLP syndrome, and HUS. All patients were managed by haemodialysis. One third of patients 7 patients (28%) required operative management in the form of evacuation of retained products of conception and 1 patient (4%) required obstetric hysterectomy. 40 % patients had complete recovery whereas 20% patients had partial recovery and rest 32 % patients had no renal recovery and were on renal replacement therapy.Maternal mortality in present study was 8 % and was attributed to septic shock, DIC, and ARDS. Foetal death occurred in 44% and rest were alive. Among all foetal birth only 32 % foetal birth were full term. CONCLUSION: Puerperal sepsis is the most common cause for
postpartum acute kidney injury. Despite improvement in antenatal care, out health care policies need to address the gaps in providing good quality pregnancy care which can go a long way in reducing maternal and foetal mortality.