Acute kidney injury related to pregnancy in developing countries: Etiology and risk factors in an intensive care unit

Background: The aim of this study was to determine etiologies, risk factors and prognosis of pregnancy-related acute kidney injury (AKI) in an intensive care unit. Methods: Patients included in this retrospective study had a gestational age exceeding 20 weeks of amenorrhea. We defined and classified AKI according to the criteria of the RIFLE classification. Patients were separated into 2 groups: group 1 with AKI and group 2 without AKI. Results: Obstetric admission cases (n=137) were compiled, including 46 cases of AKI. Comparison of the different variables between groups 1 and 2 revealed a statistically significant difference regarding home birth (p=0.004), severe hypotension (p=0.007), icterus (p=0.001), oligoanuria (p=0.001), hyperuricemia (p=0.01), thrombopenia (p=0.001) and hepatic cytolysis (p=0.001). The incidences of HELLP syndrome, abruptio placentae and disseminated intravascular coagulation were higher in the AKI group. Maternal mortality was 28.3% in group 1. Conclusion: The incidence of AKI in developing countries ranges from 4% to 36% depending on the study. In India and Pakistan, cases of pregnancy-related AKI occur mainly during the first trimester of pregnancy and are related to severe states of sepsis. In Morocco, AKI occurs mainly in the third trimester in a context of hypertensive disorders. Maternal mortality varies between 6% and 30% depending on the study. AKI is a frequently occurring complication in developing countries. It is reversible as shown by total recovery of renal function, but this depends on early and appropriate diagnosis and treatment. Nevertheless, the best treatment remains prevention. © 2011 Società Italiana di Nefrologia.