Assessment Of Characteristics Of Patients With Pregnancy Related Acute Kidney Injury In Kenyatta National Hospital

Abstract

Pregnancy related acute kidney injury (PRAKI) remains a grave complication of pregnancy. Studies on patient characteristics are few and demonstrate diverse patient features. Objective: To determine the demographic and clinical characteristics of patients with PRAKI at Kenyatta National Hospital (K.N.H) Methods: We carried out a descriptive study on women with gestation age equal to or above 28 weeks and on women in postpartum, within six weeks after delivery. The principal investigator or study assistant introduced study requirements to patients with diagnosis of PRAKI. After consent, clinical and demographic information was obtained from participants through verbal interviews and from medical records using a data capture form. Follow up was until discharge or maximum of two weeks which ever came first. Management of patients was at the discretion of the attending clinician. Results Out of 2068 admissions, 66 participants were enrolled into the study. The prevalence of PRAKI was 3.2%. The mean age was 28 years with peak age between 26-30 years. Forty-two (63.6%) were referred from other health facilities, of whom, 24(57.1%) were from rural areas. Nineteen (27.8%) had pre-pregnancy medical conditions, predominantly cardiovascular. All participants developed one or more obstetric complication: -preeclampsia 28(42.4%), eclampsia eight (9.1%) and hemolysis with elevated liver enzyme low platelet (HELLP) syndrome 17(25.8%). Sixty (91%) pregnancies were delivered. Average gestation age at delivery was 35 weeks, with 33(55%) preterm births, of whom, 10 (30.3%) were fresh still births. Severity of PRAKI at presentation was evenly distributed across stages 1 to 111. Forty-one (62.1%) participants improved on conservative management and 25(37.9%) worsened, of whom, 19 (76.0%) were dialyzed. No maternal mortality was reported during the study. Conclusion: We demonstrate a prevalence of PRAKI of 3.2% in K.N.H. Hypertensive disorders were the main associated factors. There was high rate of premature births and a six-fold increase in fresh still births among participants.