Risk Factor Evaluation in Pregnancy Related Acute Kidney Injury

Abstract

Background: Pregnancy Related Acute Kidney Injury (PRAKI) is common in developing countries. It often complicates the normal pregnancy and puerperal period with a significant proportion of morbidity and mortality related to it. Identification and early intervention of the risk factors associated to it can prevent this lifethreatening  complication. To evaluate the risk factors associated with PRAKI in a tertiary level hospital.

Materials and methods: This case control study was carried out in Dhaka Medical College Hospital for a period of one year following approval of ethical review  committee. A total of 50 subjects were enrolled as cases  who had PRAKI and 67 apparently healthy pregnant women were enrolled as controls. All patients underwent detailed history taking, physical examination and hematological and biochemical parameter. Data collection was done through a structured questionnaire and collected data were analyzed using the statistical software SPSS 23.

Results: Among cases, the frequency of past obstetric history were Pregnancy related hypertensive disorder (22%) abortion (8%) intra uterine death/stillbirth (6%) and ectopic pregnancy (2%). Among the pregnancy related risk factor pre-eclampsia/eclampsia PIH, sepsis, PPH, gestational diabetes mellitus, urinary tract infection, APH were significantly higher in compared to control (All p< 0.001 except the later one p value of which 0.003). Multivariate logistic regression analysis showed preeclampsia/  eclampsia [OR 1.104, 95% CI (1.001-1.998) p=0.049] PIH [OR 1.119, 95% CI (1.023-1.890) p=0.048] sepsis [OR 1.873, 95% CI (1.032-2.998), p=0.039] postpartum  hemorrhage [OR 2.223, 95% CI (1.921-2.990) p=0.038], increased total leucocyte count [OR 1.338, 95%  CI (1.015-3.476), p=0.049] decreased platelet count [OR .880, 95% CI (.682-.997) p p=0.016], increased D-dimer [OR 4.564, 95% CI (2.321-12.881), p=0.001] and prolonged APTT [OR 1.899, 95% CI (1.023-2.442) p=0.003] were independently associated with development of PRAKI.

Conclusion: Pregnancy related acute kidney injury (PRAKI) is a major health problem especially in the middle-income families and carries very high mortality and morbidity. Improved antenatal care and obstetric care reduce PRAKI in developed country. History of a previous hypertensive disorder of pregnancy, eclampsia, sepsis was the risk factors for development of AKI. Improvement of pregnancy care and early and appropriate Nephrological care may reduce PRAKI and mortality.

JCMCTA 2026 ; 37 (1) : 61-67