Etiology, clinical profile and prognosis of pregnancy-related acute kidney injury in critically ill obstetric patients

Objective To investigate the etiology, clinical profile and prognosis of pregnancy-related acute kidney injury (PR-AKI) in critically ill obstetric patients. Methods Data of the critically ill obstetric patients admitted to ICU from January 2011 to March 2014 were collected and analyzed retrospectively.PR-AKI patients were screened according to the clinical diagnostic criteria of AKI.The etiological diseases, laboratory indicators, urine output, length of ICU stay, prognosis of PR-AKI were documented and analyzed; and the risk factors of PR-AKI was assessed with logistic regression analysis. Results A total of 124 critically ill obstetric patients were enrolled, and AKI occurred in 46 of them (37.1%) under kidney disease: Improving Global Outeomes Acute kidney injury(KDIGO-AKI) criteria.The main causes of PR-AKI included pre-eclampsia(41.3%, 19/46), hemorrhagic shock(21.7%, 10/46), hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome (17.4%, 8/46), acute fatty liver of pregnancy (AFLP) (15.2%, 7/46). Of the 46 PR-AKI patients, 3 died (6.5%), and the causes of death was cerebral hemorrhage, cerebral venous sinus thrombosis and multiorgan failure (MOF). There were 23 cases in stage 1, 13 cases in stage 2 and 10 cases in stage 3 according to KIDGO-AKI stage criteria.Ten patients received renal replacement treatment: 1 in stage 1, 2 in stage 2 and 7 in stage 3.Complete, partial and no renal recovery was observed in 73.9% (34/46), 17.4%(8/46) and 8.7%(4/46) of the patients, respectively.Complete renal recovery was observed 91.3% (21/23) in stage 1, 9/13 in stage 2, 4/10 in stage 3, respectively.On logistic regression, pregnancy-induced hypertension, hemorrhagic shock and HELLP syndrome were risk factors of PR-AKI. Conclusions The incidence of PR-AKI in critically ill obstetric patients is high.A variety of etiological factors and risk factors are related to PR-AKI.Early detection and effective therapeutic measures are important to PR-AKI.The prognosis of PR-AKI is related with severity of AKI. Key words: Acute kidney injury; Etiology; Pregnancy; Risk factors