Outcome of pregnancy related acute kidney injury requiring haemodialysis in a Nigerian teaching hospital

Abstract

Background: Pregnancy related acute kidney injury (AKI) severe enough to require dialysis is now rare in developed countries but is still a significant cause of maternal mortality in many resource constrained countries. However, there is scanty information from many sub-Saharan countries about outcomes of patient who undergo haemodialysis. The aim of this study was to review the outcomes of women dialyzed for Pregnancy related AKI at Ahmadu Bello University Teaching Hospital Zaria, Nigeria.
Methods: Retrospective 5 year audit of patients dialyzed from 2008 to 2012.
Results: Eight (5.5%) of 150 women dialyzed within the period under review had Pregnancy related AKI. They presented 4 to 21 days after delivery with reduced urine output of 1 to 10 days (median 5 days). Only 3 (37.5%) of the 8 patients received antenatal care; 5 (62.5%) had severe haemorrhage, 4 (50%) had sepsis (2 post abortal), and 3 (37.5%) had eclampsia. Two patients died, one patient regained normal renal function and another had partial recovery of renal function. The remaining 4 (50%) were dialysis dependent at discharge but could not afford more dialysis. Foetal loss was 87.5%.
Conclusion: Peripartum haemorrhage, Sepsis and Eclampsia were the factors associated with AKI and foetal loss in our patients. Delayed recognition, late presentation, and financial constraints contributed to maternal morbidity and mortality. Lack of antenatal care may have also contributed significantly. There is urgent need to increase awareness among birth attendants (medical/traditional) and the general public about the importance of monitoring urine output after delivery and referring patients early.

Keywords: Acute Kidney Injury, Pregnancy, Haemodialysis, Renal Outcome