Changing epidemiology of acute kidney injury in pregnancy : a journey of four decades from a developing country

Abstract EN

-The incidence of acute kidney injury in pregnancy (P-AKI) has markedly decreased over the last three decades in India, particularly due to decreased incidence of postabortion AKI.

However, P-AKI still accounts for 3%–5% of cases of total AKI.

Postabortion sepsis has decreased to between 0.9% and 1.5% in 2014 from 9.4% in 1980–1990 in the new millennium.

Currently, in India, majority of P-AKI (70%–90%) occurs in the postpartum period and in late 3rd trimester similar to the developed countries, but causes are different.

We observed that preeclampsia/eclampsia is the most common cause of P-AKI in the late 3rd trimester and postpartum period followed by puerperal sepsis and postpartum hemorrhage (PPH).

Both puerperal sepsis and PPH are treatable and preventable etiologies of P-AKI.

Timely and aggressive management of antepartum hemorrhage (APH/PPH) and puerperal sepsis are required to reduce the burden of P-AKI in developing countries.

Specific-pregnancy disorders such as PaHUS/ thrombotic thrombocytopenic purpura, pregnancy-associated thrombotic microangiopathy, and acute fatty liver of pregnancy are the uncommon/rare causes of P-AKI in India and possibly also because of the lack of awareness toward diagnosis.

Despite decreasing incidence of P-AKI, fetal mortality remained high and unchanged.

However, maternal mortality has decreased to 5% from initial high mortality of 20%–25%.

The incidence and severity of renal cortical necrosis have significantly decreased at our center.