A descriptive study of acute kidney injury in obstetric patients at Kalafong Provincial Tertiary Hospital

Abstract

Background: Acute kidney injury (AKI) in pregnancy presents with complexities relating to the pathophysiology
of the disease. It is associated with an increased risk of maternal and perinatal morbidity and mortality. Cases
may be mild or severe, requiring renal replacement therapy. The physiological changes of pregnancy make
diagnosis difficult due to an increase in glomerular fi ltration rate and reduction in serum creatinine. Due to these
physiological changes, there is inadequate information to aid the precise defi nition of the disease in pregnancy. In
addition, data on AKI in pregnancy is limited in the South African population.
Aim of the study: The aim of the study was to describe the characteristics of obstetric patients who developed
AKI from 22 weeks of gestation to 6 weeks postpartum.
Methods: Pregnant women admitted to Kalafong Provincial Tertiary Hospital (KPTH) from July 2019 to July 2020
were screened based on admission status and special investigations. The inclusion criteria were all consenting
pregnant women above 18 years, gestational age of 22 weeks or more.
Results: A total of 38 patients were recruited. Twenty-fi ve (66%) of these patients had a hypertensive disorder
in pregnancy. AKI was graded as stage 1, 2 or 3 using the KDIGO classifi cation. Seventeen patients (45%)
had stage 1 AKI, 11 patients (29%) were in stage 2, and 10 (26%) were diagnosed as stage 3. Fifteen patients
(39%) were admitted to the intensive care unit. Thirty-three patients (87%) recovered fully. However, two patients
demised, of which one had an amniotic fl uid embolus complicated by postpartum haemorrhage and another was
diagnosed sepsis unrelated to the pregnancy.
Conclusion: AKI in pregnancy was associated with varying conditions, with hypertensive disorders making up
most of the conditions. However, the recovery rate was good despite the degree of AKI, with only one of the
patients in the study requiring dialysis.