title: Obstetric acute kidney injury; a three year experience at a medical college hospital in north karnataka, India.
abstract: BACKGROUND
  Acute kidney injury is a rare and sometimes fatal complication of pregnancy, the incidence of which has been declining worldwide, though still high in developing countries. There are recent observations of increasing incidence in some developed countries attributed to hypertensive disorders of pregnancy.
  
  
  METHODS
  In this study, we have analysed the records of all patients referred to the dialysis unit of a medical college hospital in Karnataka for acute kidney injury related to pregnancy. AKIN (Acute Kidney Injury Network) criteria for the diagnosis of acute kidney injury were adapted. Age, parity, gestational age, causative factors for acute kidney injury, mode of delivery, access to antenatal care, operative procedures, blood component transfusions, number of haemodialysis, time for initiation of haemodialysis, duration of hospital stay and mortality were analysed by finding mean, standard deviation and standard error.
  
  
  RESULTS
  Fifteen patients out of 21563 who delivered in our hospital developed acute kidney injury. These (n=15) were out of 149 patients of acute kidney injury of various aetiologies who underwent haemodialysis between 2012 and 2014. Of these two were unregistered for antenatal care. Ten were multiparous, Eleven were from rural background, one had home delivery, six had vaginal delivery, seven had caesarean section and two had second trimester abortion. Placental abruption with intrauterine death was the commonest Cause in 9 out of 15 cases. All had severe anaemia. Patients received a mean of 3.9 (SD+/- 2.4) sessions of haemodialysis. Eleven patients recovered completely, two died and two left against medical advice.
  
  
  CONCLUSIONS
  Obstetric acute kidney injury is associated with poor access to antenatal care, multiparity and rural background. Placental abruption is the commonest cause of obstetric acute kidney injury. Blood component transfusions, avoidance of nephrotoxic drugs and early initiation of haemodialysis are associated with better outcome.
authors.affiliation: Assistant Professor, Department of General Medicine, BIMS , Belagavi, India .
authors.forename: Archana
authors.initials: A
authors.lastname: Dambal
authors.affiliation: Assistant Professor, Department of Obstetrics and Gynaecology, BIMS , Belagavi, India .
authors.forename: K S
authors.initials: KS
authors.lastname: Lakshmi
authors.affiliation: Senior Resident, Department of Obstetrics and Gynaecology, BIMS , Belagavi, India .
authors.forename: Gousia
authors.initials: G
authors.lastname: Gorikhan
authors.affiliation: Professor and Head, Department of Obstetrics and Gynaecology, BIMS , Belagavi, India .
authors.forename: Umadi
authors.initials: U
authors.lastname: M M
authors.affiliation: Professor and Head, Department of General Medicine, BIMS , Belagavi, India .
authors.forename: Kalsad
authors.initials: K
authors.lastname: S T
authors.affiliation: Consultant, Department of Ophthalmology, Suprabha Eye Hospital , Dharwad, India .
authors.forename: Madhavaranga
authors.initials: M
authors.lastname: M P
authors.affiliation: Assistant Professor, Department of Biochemistry, Mallareddy Institute of Medical Sciences , Jedimetla, Hyderabad, India .
authors.forename: Amrut
authors.initials: A
authors.lastname: Dambal
authors.affiliation: Assistant Professor, Department of Physiology, Mallareddy Institute of Medical Sciences , Jedimetla, Hyderabad, India .
authors.forename: Samata
authors.initials: S
authors.lastname: Padaki
keywords: Abruption placentae; Antenatal care; Dialysis dependence; Hemodialysis; Multiparity; Oliguria; Puerperal sepsis