ASSESSMENT OF PREVALENCE AND OUTCOMES OF ACUTE KIDNEY INJURY DUE TO OBSTETRIC REASONS IN FEMALE PATIENTS ADMITTED TO SAINT PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE FEMALE MEDICAL WARD

Abstract

Abstract Background: Acute kidney injury is a clinical syndrome characterized by an abrupt decline in glomerular filtration rate sufficient to decrease the elimination of nitrogenous waste products and other uremic toxins (1, 2). Acute kidney injury is one of the most challenging and serious complications of pregnancy resulting in significant maternal morbidity/mortality and fetal loss. AKI in pregnancy bears a high risk of development of bilateral renal cortical necrosis and, consequently, of chronic kidney disease (5). Objective: to assess the prevalence and describe outcomes of AKI due to obstetric reasons admitted to female medical ward from September 11, 2015- February 8, 2018, SPHMMC, Addis Ababa, Ethiopia. Methods: in a hospital-based retrospective study, clinical records were reviewed study the prevalence and outcomes of AKI due to obstetric causes admitted to SPHMMC female medical ward from September 11, 2015- February 8, 2018. Results: a total of 79 patients were having AKI due to obstetric cause out of 1083 female patients in the reproductive age group (7.3%). The mean age in the study population was 27.4+5.9 SD; ranging between 16-45 yrs. Most of them were aged between 26-30 yrs. The patients came with several different clinical presentations; of these decreased urine output is the most common clinical presentation accounting more than three-quarter of the presentations (82%). By far pre-eclampsia /eclampsia was the most common identified cause of AKI presenting about 80% followed by HELLP syndrome. The mean creatinine level at admission was 6.4+ 3.4 SD (ranging 1.6-17.7) while at discharge was 2.2+ 1.2SD (ranging 0.45-7.2). 54 patients underwent hemo-dialysis which is about 68% of them. The mean number of session of dialysis that the study population underwent was calculated to be 4.4+ 2.7 (ranging 1-13); most of the patients had three session of dialysis. There only one maternal death; the immediate cause of death being respiratory failure secondary to pulmonary edema plus aspiration pneumonia. 31 of them had fetal loss which is about 39%. Conclusion: hypertensive disorders of pregnancy (preeclampsia/eclampsia), which can be easily prevented be early recognition and early intervention, are the most causes of pregnancy related AKI despite the increased antenatal care from the national coverage. The may implicate the poor quality of antenatal care to detect early enough these disorders.