Postpartum acute kidney injury: a review of 99 cases.
Postpartum acute kidney injury (PPAKI) constitutes an important cause of obstetric AKI. It is associated with high maternal and fetal mortality in developing nations. The aim of this study is to survey the etiology and outcomes of PPAKI in a tertiary care Indian hospital. Ninety-nine patients, without prior comorbidities, treated for PPAKI, between 2005-2014 at M.S. Ramaiah Medical College, were included for analysis in this retrospective, observational study. AKI was analyzed in terms of maximal stage of renal injury attained as per RIFLE criteria. Outcomes included requirement for renal replacement therapy (RRT), maternal and fetal outcomes. PPAKI constituted 60% of all obstetric AKI cases. Median maternal age was 23 years and 52% of patients were primigravidas. Mean serum creatinine was 4.1 mg/dL. Failure (33%) and injury (31%) were the major categories as per RIFLE criteria. Thirty-nine percent of cases required RRT. Sepsis, particularly puerperal sepsis, was the leading causes of PPAKI (75% of cases) and maternal mortality (94% of deaths). Maternal and fetal mortality were 19% and 22% respectively. The incidence of cortical necrosis was 10.3%. Three patients required long-term RRT. In conclusion, consistent with other Indian literature, we report a high incidence of PPAKI. We found incremental mortality on moving from "Risk" to "Failure" category of RIFLE. PPAKI was associated with high maternal and fetal mortality with sepsis being the leading cause. Our study highlights the need for provision of better quality of maternal care and fetal monitoring to decrease mortality associated with PPAKI in developing countries.
a Department of Nephrology , M S Ramaiah Medical College , MSRIT Nagar, MSRIT Post, Mathikere , Bengaluru , India.
Mahesh
M
Eswarappa
a Department of Nephrology , M S Ramaiah Medical College , MSRIT Nagar, MSRIT Post, Mathikere , Bengaluru , India.
P Rakesh
PR
Madhyastha
a Department of Nephrology , M S Ramaiah Medical College , MSRIT Nagar, MSRIT Post, Mathikere , Bengaluru , India.
Sonika
S
Puri
a Department of Nephrology , M S Ramaiah Medical College , MSRIT Nagar, MSRIT Post, Mathikere , Bengaluru , India.
Vijay
V
Varma
a Department of Nephrology , M S Ramaiah Medical College , MSRIT Nagar, MSRIT Post, Mathikere , Bengaluru , India.
Aneesh
A
Bhandari
a Department of Nephrology , M S Ramaiah Medical College , MSRIT Nagar, MSRIT Post, Mathikere , Bengaluru , India.
Gurudev
G
Chennabassappa
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India; D007673:Kidney Cortex Necrosis / Q000453:epidemiology*; D008428:Maternal Mortality; D049590:Postpartum Period; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D062606:Tertiary Care Centers; D055815:Young Adult
D003404:Creatinine
Obstetric renal failure; RIFLE criteria; postpartum acute kidney injury; postpartum renal failure; pregnancy-related acute kidney injury