Abstract:

Objective

To investigate the incidence, causes, and prognosis of pregnancy-related acute kidney injury (PR-AKI) in China.

Methods

A retrospective analysis, for 18, 589 cases of Han ethnic women from both the Obstetric and Nephrology Departments of the Shanghai Jiao Tong University Sixth People's Hospital from July 2004 to February 2013, was performed. Data of patients that conformed to the PR-AKI definition were recorded such as clinical manifestation and laboratory examinations. Variance analysis and Friedman M test were applied to analyze clinical and laboratory results of baseline, at antepartum, and at postpartum. At the same time, statistical analysis was also performed for PR-AKI incidence, causes, and pregnancy outcomes. After retrieval in Chinese and English databases, literature that was in accord with PR-AKI diagnosis, whose research subjects were Chinese women and sample size was 10 or more cases, were included for the research.

Results

From the Shanghai Jiao Tong University Sixth People's Hospital, 18 patients were diagnosed with PR-AKI. Compared with the baseline levels of patients,before termination of pregnancy, the mean arterial pressure, serum urea nitrogen, creatinine, and urine albumin increased significantly (P＜0.05), while the platelet count decreased significantly (P＜0.05). At 7 days postpartum, the urinary protein decreased significantly (P＜0.05); hemoglobin and platelet increased significantly (P＜0.05); the mean arterial pressure, serum urea nitrogen, and creatinine, were in a decline;and serum albumin was on the rise. The incidence of PR-AKI was 0. 97 ‰, whose most common cause was severe preeclampsia. At 7 days postpartum, improvement was shown in 13 cases, and renal function aggravated in 2 cases, without deaths; adverse pregnancy outcome was seen in 15 cases (78.9%), stillbirth or neonatal mortality was 31.6% (6/19). After the retrieval of 15 966 papers, 30 papers that conformed to the standard were included for analysis: the incidence of PR-AKI in our country ranged from 0.30‰ to 6.82‰;the most common causes of PR-AKI in our country were pregnancy hypertension (48.9%) and postpartum hemorrhage (13.9%); the improvement rate of PR-AKI was 81.4%; mortality was 13.5%; the percent of renal function deterioration was 5.1%; and the percent of stillbirth was 26.9%.

Conclusion

The evidence level of studies on PR-AKI was rather low. PR-AKI is worthy of attention. The prognosisofmaternal condition was good after positive treatment, but the pregnancy outcome was usually poor.

Key words: Pregnancy, Acute kidney injury, Retrospective analysis