Pre Eclampsia: Its contribution to Pregnancy Related Acute Kidney Injury. A tertiary care nephrology unit experience
Keywords:Acute Kidney Injury, Pregnancy related AKI, P-AKI, Preeclampsia, Eclampsia, HELLP syndrome, Pakistan
Preeclampsia, eclampsia and hemolysis, elevated liver enzymes and thrombocytopenia (HELLP) are among many other conditions of pregnancy related AKI (PR-AKI). Present study aims to report case series of patients with PR-AKI developing in association with preeclampsia, their course of illness and outcome.
Patients and Methods: Subjects for the study reported here comprise a cohort of 227 women coming to this institution with diagnosis of preeclampsia and AKI. Results: From January 1990 to December 2014, there were 1,441 women with PR-AKI brought to this institution among these 227 (15.75%) fulfilled the criteria of preeclampsia. On presentation 93.4% were oligo-anuric, thrombocytopenia was found in 48%, deranged INR in 18.9% and raised liver enzymes in 33.5%. On arrival 22% were in sepsis, mechanical ventilator support required in 11%. Impaired Glasgow coma scale noticed in 22%. Intra uterine death of fetus was reported in 75%. Antepartum hemorrhage in 38% and post partum hemorrhage in 32%. Renal replacement therapy in form of hemodialysis was conducted in 94.7%. Complete recovery seen in 25%, partial recovery in 31%, CKD developed in 4.4%, ESRF in 27.3% and 12 % died during acute phase of illness. Sepsis, multi-organ failure and requirement of mechanical ventilatory support on arrival were significant predictors of mortality with p value <0.001.
Conclusion: Preeclampsia and its progress to eclampsia can be a severe life-threatening condition especially when patients present with sepsis and multi organ failure. A significant number of women developed irreversible AKI and progessed to CKD.