The risk factors and outcome of early identified acute kidney injury among critically ill obstetric patients

  • Abstract
  • Keywords
  • References
  • PDF
  • Abstract

    Background: Acute kidney injury (AKI) is one of the most challenging and serious complications of pregnancy and postpartum period that facing critical care nurses in Intensive Care Unit (ICU). Having a uniform standard for identifying and classifying AKI would enhance critical care nurses’ ability to recognize these patients and leading to better outcomes.

    Objective: This work aimed to explore the risk factors and outcome of early identified acute kidney injury of critically obstetric patients in Obstetric ICU. Design. A descriptive cross sectional research design was used in this study. Participants: A total sample of 338 women admitted to Obstetric ICU at Woman Health Hospital, Assiut City, Egypt. Method: Three tools were used.Tool I was developed by the researcher and included demographic and obstetric history, lab parameters, complications and outcomes arising from AKI. The Sequential Organ Failure Assessment (SOFA) score as tool II to determine the extent of a patient's organ function or rate of failure. Measurement of serum creatinine and urine output were used to early identify AKI stages according to Acute Kidney Injury Network (AKIN) Criteria (tool III). Results: The prevalence of AKI among obstetric patients admitted to obstetric ICU was 10.1%; of them 52.9% needed renal replacement therapy and the mortality rate was 29.4%. Postpartum hemorrhage was the most common cause of AKI and its prevalence was 41.2%. It was also found that 74.5% of AKI patients developed complications. Conclusion: AKI complicated 10.1% of total admitted women to the OICU in the studied period. Postpartum hemorrhage represents the most prevalent risk factors with a highly significant SOFA score compared to other risk factors as sever preeclampsia, eclampsia, HEELP & APH with acute fatty liver.

  • Keywords

    Early Identified AKI Outcomes; Intensive Care Unit; Obstetric Complications.

  • References

      [1] GATT S. (2003) Pregnancy, delivery and the intensive care unit: need, outcome and management. Curr. Opin. Anaesthesiol., 16: 263-267,

      [2] Murugan R, Kellum JA. (2011) acute kidney injury: what's the prognosis? Nat Rev Nephrol; 7:209–17. CrossRef PubMed CAS Web of Science® Times Cited: 105

      [3] Coca SG, Singanamala S, Parikh CR. (2012) chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int; 81:4428. CrossRef | PubMed | Web of Science® Times Cited: 244

      [4] Chung KK1, Stewart IJ, Gisler C, Simmons JW, Aden JK, Tilley MA, Cotant CL, White CE, Wolf SE, Renz EM. (2012) The Acute Kidney Injury Network (AKIN) criteria applied in burns. Burn Care Res. 2012 Jul-Aug; 33 (4):483-90.

      [5] Turney JH, Ellis CM, Parsons FM. (1989) Obstetric acute renal failure 1956-1987. Br J Obstet Gynaecol; 96:679-87. CrossRefMedlineWeb of Science

      [6] Krane NK. (1988) acute renal failure in pregnancy. Arch Intern Med; 148:2347-57. CrossRefMedlineWeb of Science.

      [7] Stewart GK, Goldstein PJ. (1971) Therapeutic abortion in California. Effects of septic abortion and maternal mortality. Obstet Gynecol; 37:510-4. MedlineWeb of Science

      [8] Susana Machado, Nuno Figueiredo, Andreia Borges, Maria São José Pais, Luís Freitas, Paulo Moura, Mário Campos. (2012) Acute kidney injury in pregnancy: a clinical challenge; JNEPHROL; 25(01): 19- 30.

      [9] Rasmussen PE, Nielsen FR. (1988) Hydronephrosis during pregnancy: a literature survey. Eur J Obstet Gynecol Reprod Biol. 1988; 27(3):249-259.

      [10] Krane NK, Hamrahian M. (2007) Pregnancy: kidney diseases and hypertension. Am J Kidney Dis.; 49(2):336-345.

      [11] Walsh M, Crumbie A. (2007) Caring for the patient with a disorder of the renal and urinary systems. In: Walsh M, Crumbie A (eds.) Watson’s Clinical Nursing and Related Sciences. Balliere Tindall Elsevier, Edinburgh: 599–651

      [12] Siribamrungwong M, Chinudomwong P. (2016) Relation between acute kidney injury and pregnancy-related factors. Journal of Acute Disease; 5(1); 22–28.

      [13] Lewington A, Cerda J, Mehta R. (2013) Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney International. 2013; 84, 457-467-.

      [14] Siam S, Abd El-hameed A, Matar H. (2011) Evaluation of Acute Kidney Injury Defined by Rifle Criteria and its Association with Mortality in Critically Ill Obstetric Patients: A Retrospective Study; Med. J. Cairo Univ., Vol. 79, No. 1, December: 589-593.

      [15] Nzerue CM, Hewan-Lowe K, Nwawka C. (1998) Acute renal failure in pregnancy: a review of clinical outcomes at an inner-city hospital from 1986-1996. J Natl Med Assoc; 90:486-90.Medline

      [16] Turney JH, Marshall DH, Brownjohn AM, Ellis CM, Parsons FM. (1990) the evolution of acute renal failure, 1956-1988. Q J Med.; 74:83–104. [PubMed]

      [17] Gurrieri C, Garovic VD, Gullo A, Bojanic K, Sprung J, Narr BJ, (2012) Kidney injury during pregnancy: associated comorbid conditions and outcomes. Arch Gynecol Obstet; 286:567-73. Cross Ref Medline.

      [18] Bateman BT, Berman MF, Riley LE, Leffert LR. (2010) the epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg; 110:1368-73. CrossRefMedlineWeb of Science

      [19] Murphy F, Byrne G. (2012) The role of the nurse in the management of acute kidney injury, British Journal of Nursing, Vol 19, No 3: 146-52.

      [20] Andrew JP Lewington, Jorge Cerdá, and Ravindra L Mehta. (2013) Raising Awareness of Acute Kidney Injury: A Global Perspective of a Silent Killer; Kidney Int. 84(3): 457–467.

      [21] Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG. (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med Jul; 22(7):707-10. PMID 8844239

      [22] Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin L. (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical Care; 11(2):1–8.

      [23] Davison J. (2005) renal complications that may occur in pregnancy: The Oxford Text Book of Clinical Nephrology. 3 r ed, Vol. 15. Oxford: Oxford University Press; p. 2233-42.

      [24] Hinkle J, Cheever K. (2014) Textbook of Medical-Surgical Nursing. 13th edition: Wolters Kluwer Health/ Lippincott Williams &Wilkins; 2014. Unit 12. p. 1540

      [25] Prakash J, Vohra R, Wani IA, Murthy AS, Srivastva PK, Tripathi K, Pandey LK, Usha, and Raja R: (2007) Decreasing incidence of renal cortical necrosis in patients with acute renal failure in 10 developing countries: a single-centre experience of 22 years from Eastern India. Nephrol Dial Transplant; 22: 1213-1217.

      [26] Goplani KR, Shah PR, Gera DN, Gumber M, Dabhi M, Feroz A, Kanodia K, Suresh S, Vanikar AV, Trivedi HL. (2008) Pregnancy-related acute renal failure: A single-center experience. Indian J Nephrol; 18: 17-21.

      [27] Ostermann M and Chang R (2008): Riyadh ICU Program Users Group. Correlation between the AKI classification and outcome. Crit Care.12 (6):R144.

      [28] Godara SM, Kute VB, Trivedi HL, Vanikar AV, Shah PR, Gumber MR, Patel HV, Gumber VM. (2014) Clinical profile and outcome of acute kidney injury related to pregnancy in developing countries: A single-center study from India. Saudi J Kidney Dis Transpl; 25:906-11

      [29] Mandelbaum T, Scott DJ, Lee J, Mark RG, Malhotra A, Waikar SS, Howell MD, Talmor D. (2011) Outcome of critically ill patients with acute kidney injury using the Acute Kidney Injury Network criteria. Crit Care Med. 2011 Dec; 39(12):2659-64.

      [30] Ashraf Talaat, Elmetwally Elshahawy, Amr M. El Hammady, Mohamed El-Assal, Samir Abdullah. (2014) Epidemiology, clinical characteristics and outcome of acute kidney injury in intensive care units in Egyptian patients, Life Science Journal; 11(7):1-8.

      [31] Arrayhani M, El Youbi R, Sqalli T. (2013) Pregnancy-Related Acute Kidney Injury Volume 2013, Article ID 109034, 5 pages.

      [32] Khalil M. A., A. Azhar, N. Anwar, Aminullah, Najmud-Din, and R. Wali, (2009)“Aetiology, maternal and foetal outcome in 60 cases of obstetrical acute renal failure, Journal of Ayub MedicalCollege, vol. 21, no. 4, pp. 46–49.

      [33] Arora N., K. Mahajan, N. Jana, Taraphder A. (2010) “Pregnancy related acute renal failure in eastern India,” International Journal of Gynecology and Obstetrics, vol. 111, no., p. 213–216

      [34] Colmant C, Frydman T. R., (2009) “Y a-t-il des grossesses et des accouchements à bas risque?”Gynécologie Obstétrique & Fertilité, vol. 37, no. 2, pp. 195–199.

      [35] Schmitt R, Coca S, Kanbay M, Tinetti M, Cantley L, Parikh C. (2008): Recovery of kidney functions after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis 52: 262-271?

      [36] Dragun K, Haase M. (2010) Acute kidney failure during pregnancy and postpartum. In: Jörres A, Ronco C, Kellum J, eds. Management of acute kidney problems. Springer; Berlin. 2010:445-458.

      [37] Rordorf G, Koroshetz W, Efird JT et al., (2000): Predictors of mortality in stroke patients admitted to an intensive care unit. Crit Care Med May; 28(5):1301-5.

      [38] Najar M. S., A. R. Shah, I. A. Wani, and L. Saldanha, (2008) “Pregnancy related acute kidney injury a single center experience from the Kashmir Valley,” Indian Journal of Nephrology, vol. 18, o. 4, pp.159–161.

      [39] Ansari M. R., M. S. Laghari, and K. B. Solangi, (2008) “Acute renal failure in pregnancy: one year observational study at Liaquat University Hospital, Hyderabad,” Journal of the Pakistan MedicalAssociation, vol. 58, no. 2, pp. 61–64.

      [40] Hachim K, Badahi K, Benghanem M, Fatihi EM, Zahiri K. (2001) Obstetrical acute renal failure. Experience of nephrology department, Central University Hospital Ibn Rochd, Casablanca. Nephrologie; 22(1):29–31.

      [41] Erdemoðlu M., U. Kuyumcuoðlu, A. Kale, and N. Akdeniz. (2010) “Pregnancy-related acute renal failure in the southeast region of Turkey: analysis of 75 cases,”Clinical and Experimental Obstetrics and Gynecology, vol. 37, no. 2, pp. 148–149.

      [42] Khamis S, Emara M, Abdel-Ghani M, Naggar M. (2015) Peripartum Acute Kidney Injury; Nature and Science;13(3):1-10

      [43] Godara SM, Kute VB, Trivedi HL, Vanikar AV, Shah PR, Gumber MR, Patel HV, Gumber VM. (2014) Clinical profile and outcome of acute kidney injury related to pregnancy in developing countries: A single-center study from India; Volume: 25(Issue: 4) Page: 906-911.

      [44] Hassan I, Junejo A.M, Dawani M.L. (2009) Etiology and outcome of acute renal failure in pregnancy; J Coll Physicians Surg Pak, 19, pp. 714–717

      [45] Prakash J, Niwas SS, Parekh A, Pandey LK, Sharatchandra L, Arora P, Mahapatra AK. (2010) acute kidney injuryin late pregnancy in developing countries. Ren Fail; 32(3):309-313.




Article ID: 7170
DOI: 10.14419/ijans.v6i1.7170

Copyright © 2012-2015 Science Publishing Corporation Inc. All rights reserved.