Saudi Journal of Kidney Diseases and Transplantation

RENAL DATA FROM ASIA–AFRICA
Year
: 2019  |  Volume : 30  |  Issue : 5  |  Page : 1118--1130

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


Jai Prakash, Suraj Prakash, Vivek C Ganiger 
 Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Correspondence Address:
Jai Prakash
Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh
India

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 P-aHUS/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.


How to cite this article:
Prakash J, Prakash S, Ganiger VC. Changing epidemiology of acute kidney injury in pregnancy: A journey of four decades from a developing country.Saudi J Kidney Dis Transpl 2019;30:1118-1130


How to cite this URL:
Prakash J, Prakash S, Ganiger VC. Changing epidemiology of acute kidney injury in pregnancy: A journey of four decades from a developing country. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2021 Oct 26 ];30:1118-1130
Available from: https://www.sjkdt.org/article.asp?issn=1319-2442;year=2019;volume=30;issue=5;spage=1118;epage=1130;aulast=Prakash;type=0