Incidence of Pregnancy-Related Acute Kidney Injury in a Low Resource Setting: A Prospective Study

Background: Pregnancy-related acute kidney injury (PRAKI) is a common cause of AKI globally. The incidence and burden of PRAKI are still high in low and middle-income countries (LMICs) especially in Africa due to limited access to optimal obstetric care, late diagnosis, and referral. The study aimed to determine the incidence and aetiologies of PRAKI among women in the peripartum period in two government hospitals in Nigeria.

Methodology: This was a prospective study where serum creatinine was measured among pregnant women presenting in labour at 0 hours, 6 hours, 12 hours, 24 hours, 48hour and 7 days post-delivery. AKI was defined using the Kidney Disease Improving Global Outcome criteria. Binary logistic regression was used to determine predictors of PRAKI.

Results: The mean age of the 162 pregnant women who completed the study was 30.05±1.28 years. The incidence of AKI use was 22.2%. The aetiologies of PRAKI were obstetric haemorrhage (66.7%), eclampsia (19.4%), and sepsis (13.9%). Seventeen (47.2%) patients had Stage 1 PRAKI, 12 (33.3%) had Stage 2 PRAKI, while seven (19.4%) had Stage 3 PRAKI. Factors significantly associated with PRAKI were parity (p=<0.001), caesarean section (p=<0.001), excess blood loss (p=<0.001), and prolonged duration of labour (p=0.002).

Conclusion: PRAKI occurred in 1 out 5 pregnant women in the peripartum period. Obstetric haemorrhage, sepsis, and eclampsia which are preventable or treatable are common major aetiologies of PRAKI. PRAKI is more associated with multi-parity, caesarean delivery, haemorrhage, and prolonged duration of labour. Optimal ante-natal care, health education, and prompt diagnosis and management of obstetric complications will reduce the incidence in Nigeria.

背景：妊娠相关急性肾损伤（Pregnancy-related acute kidney injury, PRAKI）是全球范围内急性肾损伤（acute kidney injury, AKI）的常见病因。在低收入和中等收入国家（low and middle-income countries, LMICs），尤其是非洲地区，由于获得优质产科护理的机会有限、诊断延迟及转诊不及时，PRAKI的发病率和疾病负担仍居高不下。本研究旨在明确尼日利亚两家政府医院中围产期女性PRAKI的发病率及病因。

方法论：本研究为前瞻性研究，对临产孕妇在产后0小时、6小时、12小时、24小时、48小时及7天测定血清肌酐水平。AKI采用肾脏疾病全球改善组织（Kidney Disease Improving Global Outcomes, KDIGO）标准进行定义。采用二元逻辑回归分析确定PRAKI的预测因素。

结果：完成研究的162名孕妇平均年龄为30.05±1.28岁。PRAKI发病率为22.2%。PRAKI的病因包括产科出血（66.7%）、子痫（19.4%）及脓毒症（13.9%）。其中17例（47.2%）为PRAKI 1期，12例（33.3%）为2期，7例（19.4%）为3期。与PRAKI显著相关的因素包括产次（p<0.001）、剖宫产（p<0.001）、失血过多（p<0.001）及产程延长（p=0.002）。

结论：围产期每5名孕妇中即有1例发生PRAKI。产科出血、脓毒症及子痫等可预防或可治疗的疾病是PRAKI的常见主要病因。PRAKI与多产次、剖宫产、出血及产程延长的关联更为密切。在尼日利亚，优化产前护理、开展健康教育以及及时诊断和处理产科并发症将有助于降低PRAKI的发病率。