Acute kidney injury in pregnant women with chronic kidney disease
https://doi.org/10.28996/2618-9801-2019-2-213-220
Abstract
Aim: to study the incidence, predisposing factors, causes and outcomes of pregnancy-related acute kidney injury (AKI) in patients with chronic kidney disease (CKD). Methods: The study included 305 pregnancies in 291 women with CKD stages 1-4 (mean age 29.4 [25.8; 32.9] years; the duration of CKD 12.0 [5.0, 21.0] years). During pregnancy and after childbirth diuresis, creatinine level, and GFR were studied. The KDIGO criteria were used to identify AKI. Results: AKI on CKD developed in 35 of 305 (11.5%) pregnancies in 34 (11.7%) of 291 women (one patient had AKI in each of two pregnancies). A total of 37 episodes of AKI were recorded. The incidence of AKI on CKD stage 1 was 1.0%, stage 2 - 4.3%, stage 3A - 46.9%, stage 3B - 50.0%, and stage 4 - 71.4% (p<0.001). The risk of AKI on CKD increased with arterial hypertension, nephrotic proteinuria, CKD 3-4 stage, anemia, preeclampsia, placental insufficiency, cesarean section. The main cause of AKI (67.6% cases) was preeclampsia. In the AKI group, compared to pregnancies without AKI, gestational age at delivery and percentile birth weight were less - 35.3 [32.6; 37.1] vs 38.3 [37.3; 39.6] weeks, p<0.001, and 29.8 [12.4; 51.5] vs 44.5 [21.1; 66.6], p=0.014, respectively. In the follow-up, 35.3% of patients who had AKI on CKD during pregnancy progressed to stage 5 CKD and started dialysis, compared with 2.3% in women without AKI (p<0.001). Conclusion: AKI on CKD often occurs during gestation and impact negatively on pregnancy outcomes for the mother and fetus.
About the Authors
E. I. Prokopenko
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation
Russian Federation
I. G. Nikolskaya
Moscow Regional Research Institute of Obstetrics and Gynecology
Russian Federation
Russian Federation
D. V. Penzeva
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation
Russian Federation
E. V. Shestero
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation
Russian Federation
References
1. Coca S.G., Yusuf B., Shlipak M.G., Garg A.X., Parikh C.R. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am. J. Kidney Dis. 2009; 53: 961-973. DOI: 10.1053/j.ajkd.2008.11.034
2. Bydash J.R., Ishani A. Acute kidney injury and chronic kidney disease: a work in progress. Clin. J. Am. Soc. Nephrol. 2011; 6: 2555-2557. DOI: 10.2215/CJN.09560911
3. Coca S.G., Singanamala S., Parikh C.R. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012; 81: 442-448. DOI: 10.1038/ki.2011.379
4. Chawla L.S., Kimmel P.L. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int. 2012; 82: 516-524. DOI:10.1038/ki.2012.208
5. Forni L.G., Darmon M., Ostermann M., Oudemans-van Straaten HM., Pettilä V., Prowle JR., Schetz M., Joannidis M. Renal recovery after acute kidney injury. Intensive Care Med. 2017; 43(6): 855-866. DOI: 10.1007/s00134-017-4809-x
6. Sawhney S., Mitchell M., Marks A., Fluck N., Black C. Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review. BMJ Open. 2015; 5(1): e006497. DOI: 10.1136/bmjopen-2014-006497
7. Piccoli G.B., Zakharova E., Attini R., Ibarra Hernandez M., Covella B., Alrukhaimi M., Liu Z.H., Ashuntantang G., Orozco Guillen A., Cabiddu G., Li P.K.T., Garcia-Garcia G., Levin A. Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases. J. Clin. Med. 2018; 7(10). pii: E318. DOI: 10.3390/jcm7100318
8. Acharya A., Santos J., Linde B., Anis K. Acute kidney injury in pregnancy-current status. Adv. Chronic Kidney Dis. 2013; 20(3): 215-222. DOI: 10.1053/j.ackd.2013.02.002
9. Acharya A. Management of acute kidney injury in pregnancy for the obstetrician. Obstet. Gynecol. Clin.N. Am. 2016; 43: 747-765. DOI: 10.1016/j.ogc.2016.07.007
10. Lombardi R., Rosa-Diez G., Ferreiro A., Greloni G., Yu L., Younes-Ibrahim M., Burdmann E.A. Acute kidney injury in Latin America: a view on renal replacement therapy resources. Nephrol. Dial. Transplant. 2014; 29: 1369-1376. DOI: 10.1093/ndt/gfu078
11. Srinil S., Panaput T. Acute kidney injury complicating septic unsafe abortion: Clinical course and treatment outcomes of 44 cases. J. Obstet. Gynaecol. Res. 2011; 37: 1525-1531. DOI: 10.1111/j.1447-0756.2011.01567.x
12. Sabban H., Zakhari A., Patenaude V., Tulandi T., Abenhaim H.A. Obstetrical and perinatal morbidity and mortality among in-vitro fertilization pregnancies: A population-based study. Arch. Gynecol. Obstet. 2017; 296: 107-113. DOI: 10.1007/s00404-017-4379-8
13. Ibarra-Hernández M., Orozco-Guillén OA., de la Alcantar-Vallín ML., Garrido-Roldan R., Jiménez-Alvarado M.P., Castro K.B., Villa-Villagrana F., Borbolla M., Gallardo-Gaona J.M., García-García G., Reyes-Paredes N., Piccoli G.B. Acute kidney injury in pregnancy and the role of underlying CKD: a point of view from México. J. Nephrol. 2017; 30(6): 773-780. DOI: 10.1007/s40620-017-0444-4
14. Piccoli G.B., Cabiddu G., Castellino S., Gernone G., Santoro D., Moroni G., Spotti D., Giacchino F., Attini R., Limardo M., Maxia S., Fois A., Gammaro L., Todros T. A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: The Italian study group on kidney and pregnancy. J. Nephrol. 2017; 30: 307-317. DOI: 10.1007/s40620-017-0390-1
15. Blom K., Odutayo A., Bramham K., Hladunewich M.A. Pregnancy and glomerular disease: a systematic review of the literature with management guidelines. Clin. J. Am. Soc. Nephrol. 2017; 12(11):1862-1872. DOI: 10.2215/CJN.00130117
16. Piccoli G.B., Cabiddu G., Attini R., Vigotti F.N., Maxia S., Lepori N., Tuveri M., Massidda M., Marchi C., Mura S. Risk of adverse pregnancy outcomes in women with CKD. J. Am. Soc. Nephrol. 2015; 26: 2011-2022. DOI: 10.1681/ASN.2014050459
17. Zhang J.J., Ma X.X., Hao L., Liu L.J., Lv J.C., Zhang H. A systematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy. Clin. J. Am. Soc. Nephrol. 2015; 10: 1964-1978. DOI: 10.2215/CJN.09250914
18. Никольская И.Г., Прокопенко Е.И., Ватазин А.В., Будыкина Т.С. Ангиогенные и антиангиогенные факторы у беременных с хронической болезнью почек: роль коэффициента sFlt-1/PlGF в прогнозировании и диагностике преэклампсии. Нефрология и диализ. 2016; 18(4): 440-451.
19. Fabjan-Vodusek V., Kumer K., Osredkar J., Verdenik I., Gersak K., Premru-Srsen T. Correlation between uterine artery Doppler and the sFlt-1/PlGF ratio in different phenotypes of placental dysfunction. Hypertens. Pregnancy. 2019; 38(1): 32-40. DOI: 10.1080/10641955.2018.1550579
20. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012; 1:1-126.
21. Нефрология. Клинические рекомендации/ под ред. Е.М. Шилова, А.В. Смирнова, Н.Л. Козловской. М., ГЭОТАР-Медиа, 2016; 816 с
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For citations:
Prokopenko E.I., Nikolskaya I.G., Penzeva D.V., Shestero E.V. Acute kidney injury in pregnant women with chronic kidney disease. Nephrology and Dialysis. 2019;21(2):213-220. (In Russ.) https://doi.org/10.28996/2618-9801-2019-2-213-220
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