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Pregnancy-Related Acute Kidney Injury, Dialysis Versus Conservative Management in the Nephrology Ward

Aim: To determine the overall frequency of patients suffering from P-AKI in the third trimester requiring dialysis as compared to conservative management. Study Design: Prospective study Place and Duration: Nephrology department of Fatima Jinnah Medical University/Sir Ganga Ram Hospital, Lahore from 3rd June 2017 to 31st December 2017. Methodology: 106 pregnant women having age 15 to 45 years with AKI during the third trimester or postpartum period (42 days of delivery) who were hemodynamically stable and shifted to the Nephrology department without any surgical intervention or ICU requirements were included in the study. For the diagnosis of AKI, KDIGO guidelines were utilized. After taking informed consent from patients, current clinical data, baseline S. Cr before pregnancy, and current renal function tests were recorded. Clinical progress was monitored, and patients were treated as per SOPs of the department. Records of conservative management and dialysis were made. Patients were followed up from the day of admission to the date of discharge. Results: The mean age of the patients was 27 ± 4.169 years. Almost 70% (n=74) of the patients had age 15-29 years, while 30 % (n=32) of patients had age 30-45 years. The mean creatinine of the patients was 4.76 ± 3.55 mg/dl. The frequency of patients requiring dialysis was 23.6% (n=25) and 76.4% patients (n=81) were treated conservatively. Patients who received conservative management, 55 patients (67.9%) had full recovery of renal functions, 25(30.9%) had mildly raised serum creatinine (1.3 to 2mg/dl), and only 1.2% had S. Cr of more than 3mg/dl. 14(56%) were off hemodialysis while 11(44%) were needed regular hemodialysis. Of those who were off hemodialysis, 6(24%) had complete recovery, 5(20%) had mildly raised serum creatinine and 1(4%) had moderate derangement of S.Cr. Of those patients who were discharged on dialysis 13(52%) had severely deranged serum creatinine. Conclusion: It is concluded that conservative treatment is effective for renal recovery with short hospital stay. Sepsis is leading cause of P-AKI in third trimester. HD is required only in 23.6% of P-AKI patients in Nephrology ward. Keywords: Pregnancy, Acute Kidney Injury, Conservative Management, Dialysis