Pregnancy-related acute kidney injury prevalent in women with pre-eclampsia

Women with pre-eclampsia commonly have acute kidney injury (AKI), which is associated with higher rates of maternal and perinatal mortality, a study reports.

The study followed a total of 1,547 women admitted with pre-eclampsia who presented with maximum creatinine concentration of ≥90 μmol/L during admission in South Africa. Of these, 237 patients (15.3 percent) met the AKI criteria: 107 (6.9 percent) had stage 1 disease, 67 (4.3 percent) had stage 2 disease and 63 (4.1 percent) had stage 3 disease.

Women with vs without AKI were at greater risk of maternal death (relative risk, 4.3, 95 percent CI, 1.6–11.4) and stillbirth (relative risk, 2.2, 1.8–2.8). Additionally, perinatal mortality was high in women with AKI (89 of 240; 37.1 percent).

Hypertension in a previous pregnancy emerged as the strongest predictor of AKI stage 2 or 3 (odds ratio, 2.24, 1.21–4.17). Renal recovery rate decreased with increasing AKI stage. By discharge, renal function did not return to baseline in about a third of the surviving women (76 of 230; 33.0 percent), approximately half of whom (39 of 76; 51.3 percent) did not have further creatinine testing postdischarge.

Researchers highlighted a need for additional investigation to determine the short- and long-term outcomes of pregnancy-related AKI and whether this varies according to underlying pathogenesis. They encouraged clinicians to follow-up women with AKI whose renal function did not return to baseline at discharge.