Obstetrical Acute Kidney Injury: 25 Years’ Experience from Nephrology Care Unit in Pakistan

Objective: We aim to report observations from patients who developed acute kidney injury after complicated obstetrics and referred to our institution. Patients and Methods: Observational cohort of patients identified as having acute kidney injury (AKI) in obstetrical situation, at a tertiary center in Pakistan, from January 1990-December 2014. AKI was defined according to RIFLE criteria and patients fall from Risk to Loss category on arrival. On ultrasonography, all women had normal size non obstructed kidneys, and no other co morbid. Results: Between Jan. 1990 to Dec. 2014, 1441 (which is 25.62% of total AKI) women with obstetrical AKI registered to this hospital. Most common causes were peripartal excessive blood loss, abruptio placentae, intra uterine fetal death, followed by sepsis, pre-eclampsia, eclampsia, abortions, surgical trauma, exposure to nephrotoxic antimicrobials and hemolysis with blood transfusion reaction. There was frequent coexistence of more than one reason in majority of patients. Acute cortical necrosis (ACN) reported on ultrasonography in 420 and on biopsy in 87 women. Renal replacement therapy was required on arrival in 94% cases. Complete renal recovery observed in 30.98%, while 12.14% expired during acute phase, renal replacement therapy beyond 90 days required in 20.21% and 17.67% disappeared either in state of partial recovery or in the beginning, refusing renal replacement altogether. We divided the population in four groups, from 1990-1999 (10 years), then 2000-2004, 2005-2009 and 2010-2014, each 5 years, and then we compared if there is any change in trends during different time periods. Conclusion: In this part of world, poor health infra structure still causes complications in obstetrical situation which can result deaths in young women or requirement for lifelong renal replacement.