Clinical Features and Outcomes of Pregnancy-Related AKI: A Single Tertiary Center Study

Abstract

Background: Pregnancy-related acute kidney injury (Pr-AKI) is a major cause of maternal and fetal morbidity and mortality in developing countries. The aim of our study was to study the clinical characteristics and outcomes of patients with Pr-AKI at our center. Methods: This prospective study at Zagazig University Hospital, Egypt, from October 1, 2023, to March 1, 2024, included patients with post-partum AKI. These women were compared to a matched cohort of healthy pregnant women without pre-existing AKI.Multivariate analysis is used to identify risk factors. Results: Out of 900 pregnant patients who delivered during the study period, 52 patients developed post-partum AKI with incident of 5.7%. The majority were multiparous( 59.6%), and most delivered by cesarean section (67.3%).The most common cause of AKI is preeclampsia (51.9%) , followed by ante-partum hemorrhage (40.4%) and HEELP syndrome (36.5%). Stage 3 AKI (KDIGO classification) was the most prevalent occurring in 23% of cases. Maternal death occurred in 13.5% of cases, while fetal death was 17.3%. Follow- up showed that 42.3% had complete recovery, 30.7% CKD and 13.4% remained dialysis-dependent. Risk factors for AKI included high WBC, low Hb, low platelets, and high bilirubin levels, with p-values of 0.004, <0.0001, and 0.031, respectively. Additionally, nulliparous women had significantly lower odds of developing AKI (0.248, p = 0.017). However, the significance of these risk factors disappeared in multivariate analysis. Conclusion: Post-partum AKI is a relatively common pregnancy complication with significant maternal and fetal mortality risks. Preeclampsia and ante-partum hemorrhage are major risk factors. Larger, long-term follow-up studies are recommended to confirm these findings. Funding: Private Foundation Support