Introduction. Acute kidney injury (PRAKI) continues to be common in developing countries. The aim of this paper is to study AKI characteristics in pregnancy and identify the factors related to the unfavorable evolution. Methods. This prospective study was conducted in the University Hospital Hassan II of Fez, Morocco, from February 01, 2011 to January 31, 2012. All patients presenting PRAKI were included. Results. 37 cases of PRAKI were listed. Their ages varied from 20 to 41 years old, with an average of 29.03 ± 6.3 years and an average parity of 1.83. High blood pressure was the most common symptom (55.6%). Thirty-nine percent were oliguric. PRAKI occurred during the 3rd trimester in 66.6% of the cases and 25% of the cases in the postpartum. Hemodialysis was necessary in 16.2% of cases. The main causes were preeclampsia, hemorrhagic shocks, and functional, respectively, in 66.6%, 25%, and 8.3% of the cases. The outcome was favorable, with a complete renal function recovery for 28 patients. Poor prognosis was related to two factors: age over 38 years and advanced stage of AKI according to RIFLE classification. Conclusion. Prevention of PRAKI requires an improvement of the sanitary infrastructures with the implementation of an obligatory prenatal consultation. 1. Introduction Acute kidney injury represents a challenging clinical when it occurs during pregnancy. The worldwide incidence of pregnancy-related acute kidney injury (PRAKI) has decreased markedly in the past 50 years from 20–40% in 1960 to less than 10% in the current series through the legalization of abortion and improvement of antenatal and obstetric care [1]. In the recent years, the incidence of PRAKI has decreased in developed countries to only 1% to 2.8%. It is a rare complication of pregnancy following the disappearance of septic abortion and a better perinatal care [2, 3]. However, PRAKI is still frequent in developing countries; the incidence is around 4.2–15% [2]. Caring for women diagnosed with acute kidney injury is a real challenge for nephrologists and all the medical team. PRAKI is usually caused by septic abortion in early pregnancy, by pregnancy toxemia, hemorrhages during pregnancy (antepartum and postpartum), and acute tubular necrosis in late pregnancy [4, 5]. Acute fatty liver is an uncommon cause of PRAKI. It occurs in the third trimester of pregnancy. Puerperal sepsis and thrombotic microangiopathy are seen in the postpartum period. Acute tubular necrosis (ATN) is the most common condition with a good prognosis compared to other pathology like severe eclampsia, HELLP
References
[1]
K. S. Kumar, C. R. Krishna, and V. S. Kuma, “Pregnancy related acute renal failure,” Journal of Obstetrics & Ganecology of India, vol. 56, no. 4, pp. 308–310, 2006.
[2]
K. R. Goplan, D. N. Gero, et al., “Pregnany related acute renal failure: a single center experience,” Indian Journal of Nephrology, vol. 18, no. 1, pp. 17–21, 2008.
[3]
P. U. Rani and G. Narayen, “Anuradha. Changing trends in pregnancy related acute renal failure,” Journal of Obstetrics & Ganecology of India, vol. 52, pp. 36–38, 2002.
[4]
M. B. Beaufils, “Pregnancy,” in Clinical Nephrology, A. M. Davidson, J. S. Cameron, J. P. Grunfeld, et al., Eds., pp. 1704–1728, Oxford University Press, New York, NY, USA, 3rd edition, 2005.
[5]
J. Prakash, K. Tripathi, L. K. Pandey, S. R. Gadela, and Usha, “Renal cortical necrosis in pregnancy-related acute renal failure,” Journal of the Indian Medical Association, vol. 94, no. 6, pp. 227–229, 1996.
[6]
N. Pertuiset and J. P. Grünfeld, “Acute renal failure in pregnancy,” Bailliere's Clinical Obstetrics and Gynaecology, vol. 8, no. 2, pp. 333–351, 1994.
[7]
R. W. Schrier, Diseases of Kidney & Urinary Tract, Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 2001.
[8]
M. A. Khalil, A. Azhar, N. Anwar, Aminullah, Najm-ud-Din, and R. Wali, “Aetiology, maternal and foetal outcome in 60 cases of obstetrical acute renal failure,” Journal of Ayub Medical College, vol. 21, no. 4, pp. 46–49, 2009.
[9]
N. Arora, K. Mahajan, N. Jana, and A. Taraphder, “Pregnancy-related acute renal failure in eastern India,” International Journal of Gynecology and Obstetrics, vol. 111, no. 3, pp. 213–216, 2010.
[10]
L. Altintepe, K. Gezgin？, H. Z. Tonbul et al., “Etiology and prognosis in 36 acute renal failure cases related to pregnancy in central Anatolia,” European Journal of General Medicine, vol. 2, no. 3, pp. 110–113, 2005.
[11]
I. G. H. Randeree, A. Czarnocki, J. Moodley, Y. K. Seedat, and I. P. Naiker, “Acute renal failure in pregnancy in South Africa,” Renal Failure, vol. 17, no. 2, pp. 147–153, 1995.
[12]
M. S. Najar, A. R. Shah, I. A. Wani, and L. Saldanha, “Pregnancy related acute kidney injury a single center experience from the Kashmir Valley,” Indian Journal of Nephrology, vol. 18, no. 4, pp. 159–161, 2008.
[13]
Q. A. Shaikhdr, N. A. Shaikh, A. A. Soomro, G. S. Shaikh, and A. R. Shaikh, “Pregnancy related acute renal failure: an experience at nephro-urology department Chandka medical college teaching hospital Larkana,” Professional Medical Journal, vol. 15, no. 1, pp. 129–132, 2008.
[14]
J. E. Ventura, M. Villa, R. Mizraji, and R. Ferreiros, “Acute renal failure in pregnancy,” Renal Failure, vol. 19, no. 2, pp. 217–220, 1997.
[15]
M. Erdemo？lu, U. Kuyumcuo？lu, A. Kale, and N. Akdeniz, “Pregnancy-related acute renal failure in the southeast region of Turkey: analysis of 75 cases,” Clinical and Experimental Obstetrics and Gynecology, vol. 37, no. 2, pp. 148–149, 2010.
[16]
M. R. Ansari, M. S. Laghari, and K. B. Solangi, “Acute renal failure in pregnancy: one year observational study at Liaquat University Hospital, Hyderabad,” Journal of the Pakistan Medical Association, vol. 58, no. 2, pp. 61–64, 2008.
[17]
V. Sivakumar, G. Sivaramakrishna, and V. V. Sainaresh, “Pregnancy related acute renal failure: a ten year experience,” Saudi Journal of Kidney Diseases and Transplantation, vol. 22, no. 2, pp. 352–353, 2011.
[18]
B. M. Sibai, M. A. Villar, and B. C. Mabie, “Acute renal failure in hypertensive disorders of pregnancy. Pregnancy outcome and remote prognosis in thirty-one consecutive cases,” American Journal of Obstetrics and Gynecology, vol. 162, no. 3, pp. 777–783, 1990.
[19]
C. Utas, C. Yalcindag, H. Taskapan, M. Guven, O. Oymak, and M. Yucesoy, “Acute renal failure in Central Anatolia,” Nephrology Dialysis Transplantation, vol. 15, no. 2, pp. 152–155, 2000.
[20]
B. Moulin, A. Hertigb, and E. Rondeaub, “Rein et pré-éclampsie,” Annales Fran？aises d'Anesthésie et de Réanimation, vol. 29, no. 4, pp. 83–90, 2010.
[21]
F. Guillibert, M. Varlet, B. Hammel, et al., “Troubles hydro-électrolytiques pendant la grossesse : complications maternelles et f？tales,” Journal de Gynécologie Obstétrique et Biologie de la Reproduction, vol. 38, no. 1, pp. 94–97, 2009.
[22]
C. Colmant and T. R. Frydman, “Y a-t-il des grossesses et des accouchements à bas risque?” Gynécologie Obstétrique & Fertilité, vol. 37, no. 2, pp. 195–199, 2009.
[23]
L. Weinstein, “Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy,” American Journal of Obstetrics and Gynecology, vol. 142, no. 2, pp. 159–167, 1982.
[24]
K. R. Goplani, P. R. Shah, D. N. Gera, et al., “Pregnancy-related acute renal failure: a single-center experience,” Indian Journal of Nephrology, vol. 18, no. 1, pp. 17–21, 2008.
[25]
S. Ben Hamouda, H. Khoudayer, H. Ben Zina, et al., “La morbidité maternelle grave,” Journal de Gynécologie Obstétrique et Biologie de la Reproduction, vol. 36, no. 7, pp. 694–698, 2007.
[26]
N. Chaudhri, G. U. But, I. Masroor, et al., “Spectrum and short term outcome of pregnancy related acute renal failure among women,” Annals of Pakistan Institute of Medical Sciences, vol. 7, no. 2, pp. 57–61, 2011.
