Obstetrical Acute Kidney Injury: 25 Years’ Experience from Nephrology Care Unit in Pakistan


Objective: We aim to report observations from patients who developed acute kidney injury after complicated obstetrics and referred to our institution. Patients and Methods: Observational cohort of patients identified as having acute kidney injury (AKI) in obstetrical situation, at a tertiary center in Pakistan, from January 1990-December 2014. AKI was defined according to RIFLE criteria and patients fall from Risk to Loss category on arrival. On ultrasonography, all women had normal size non obstructed kidneys, and no other co morbid. Results: Between Jan. 1990 to Dec. 2014, 1441 (which is 25.62% of total AKI) women with obstetrical AKI registered to this hospital. Most common causes were peripartal excessive blood loss, abruptio placentae, intra uterine fetal death, followed by sepsis, pre-eclampsia, eclampsia, abortions, surgical trauma, exposure to nephrotoxic antimicrobials and hemolysis with blood transfusion reaction. There was frequent coexistence of more than one reason in majority of patients. Acute cortical necrosis (ACN) reported on ultrasonography in 420 and on biopsy in 87 women. Renal replacement therapy was required on arrival in 94% cases. Complete renal recovery observed in 30.98%, while 12.14% expired during acute phase, renal replacement therapy beyond 90 days required in 20.21% and 17.67% disappeared either in state of partial recovery or in the beginning, refusing renal replacement altogether. We divided the population in four groups, from 1990-1999 (10 years), then 2000-2004, 2005-2009 and 2010-2014, each 5 years, and then we compared if there is any change in trends during different time periods. Conclusion: In this part of world, poor health infra structure still causes complications in obstetrical situation which can result deaths in young women or requirement for lifelong renal replacement.

Share and Cite:

Naqvi, R. , Ahmed, E. , Sheikh, R. and Rizvi, A. (2015) Obstetrical Acute Kidney Injury: 25 Years’ Experience from Nephrology Care Unit in Pakistan. Open Access Library Journal, 2, 1-7. doi: 10.4236/oalib.1101778.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Krane, N.K. (1992) Acute Renal Failure in Pregnancy. Nephrologia, 12, 115-125.
[2] Chugh, K.S., Singhal, P.C., Sharma, B.K., Pal, Y., Mathew, M.T., Dhall, K. and Datta, B.N. (1976) Acute Renal Failure of Obstetric Origin. Obstetrics & Gynecology, 48, 642-646.
[3] Patel, M.L., Sachan, R., Radheshyam and Sachan, P. (2013) Acute Renal Failure in Pregnancy: Tertiary Centre Experience from North Indian Population. Nigerian Medical Journal, 54, 191-195.
[4] Ali, A., Zafar, S. and Mehmood, A. (2004) Obstetrical Acute Renal Failure from Frontier Province: A Three Years Prospective Study. Journal of Postgraduate Medical Institute, 18, 109-117.
[5] Ansari, M.R. and Laghari, M.S. (2008) Acute Renal Failure in Pregnancy: One Year Observational Study at Liaquat University Hospital, Hyderabad. Journal of Pakistan Medical Association, 58, 61-64.
[6] Rabbani, M.A., Habib, H.B., Siddiqui, B.K., Tahir, M.H., Ahmad, B., Murtaza, G., Maria, Q. and Ahmad, A. (2008) Etiology of Acute Renal Failure in a Tertiary Center. Saudi Journal of Kidney Diseases and Transplantation, 19, 1009-1014.
[7] Zarjou, A. and Agarwal, A. (2011) Sepsis and Acute Kidney Injury. JASN, 22, 999-1006.
[8] Mehta, R.L., Cerdá, J., Burdmann, E.A., Marcello Tonelli, M., et al. (2015) International Society of Nephrology’s 0by25 Initiative for Acute Kidney Injury (Zero Preventable Deaths by 2025): A Human Rights Case for Nephrology. The Lancet, in Press.
[9] Arrayhani, M., Youbi, R.E. and Sqalli, T. (2013) Pregnancy-Related Acute Kidney Injury: Experience of the Nephrology Unit at the University Hospital of Fez, Morocco. ISRN Nephrology, 2013, Article ID: 109034.
[10] Okunola, O.O., Ayodele, O.E. and Adekanle, A.D. (2012) Acute Kidney Injury Requiring Hemodialysis in the Tropics. Saudi Journal of Kidney Diseases and Transplantation, 23, 1315-1319.
[11] Mehrabadi, A., Liu, S., Bartholomew, S., Hutcheon, J.A., Magee, L.A., Kramer, M.S., Liston, R.M. and Joseph, K.S. (2014) Hypertensive Disorders of Pregnancy and the Recent Increase in Obstetric Acute Renal Failure in Canada: Population Based Retrospective Cohort Study. British Medical Journal, 349, g4731.
[12] Russell, K.P., Maharry, J.F. and Stehly, J.W. (1955) Acute Renal Failure as an Obstetric Complication. The Journal of the American Medical Association, 157, 15-20.
[13] Turney, J.H., Ellis, C.M. and Parsons, F.M. (1989) Obstetric Acute Renal Failure 1956-1987. British Journal of Obstetrics and Gynaecology, 96, 679-687.
[14] Chugh, K.S., Sakhuja, V., Malhotra, H.S. and Pereira, B.J. (1989) Changing Trend in Acute Renal Failure in Third-World Countries: Chandigarh Study. Quarterly Journal of Medicine, 73, 1117-1123.
[15] Jayakumar, M., Prabahar, M.R., Fernando, E.M., Manorajan, R., Venkatraman, R. and Balaraman, V. (2006) Epidemiologic Trend Changes in Acute Renal Failure—A Tertiary Center Experience from South India. Renal Failure, 28, 405-410.
[16] Goplani, K.R., Shah, P.R., Gera, D.N., Gumber, M., Dabhi, M., Feroz, A., Kanodia, K., Suresh, S., Vanikar, A.V. and Trivedi, H.L. (2008) Pregnancy-Related Acute Renal Failure: A Single-Center Experience. Indian Journal of Nephrology, 18, 17-21.
[17] Rashid, H., Akram, M. and Malik, M.B. (2013) Acute Renal Failure in Pregnancy, Its Causes and Outcome, One Year Study at Shaikh Zayed Hospital Lahore. Annals, 19, 33-36.
[18] Naqvi, R., Akhtar, F., Ahmed, E., Sheikh, R., Ahmed, Z., Naqvi, A. and Rizvi, A. (1996) Acute Renal Failure of Obstetric Origin during 1994 at One Center. Renal Failure, 18, 681-683.
[19] Chugh, K.S., Jha, V., Sakhuja, V. and Joshi, K. (1994) Acute Renal Cortical Necrosis—A Study of 113 Patients. Renal Failure, 16, 37-47.
[20] Alexopoulos, E., Tambakoudis, P., Bili, H., Sakellariou, G., Mantalenakis, S. and Papadimitriou, M. (1993) Acute Renal Failure in Pregnancy. Renal Failure, 15, 609-613.
[21] Krane, N.K. and Batuman, V. (2013) Renal Disease and Pregnancy. Medscape.
[22] Fakhouri, F., Vercel, C. and Frémeaux-Bacch, V. (2012) Obstetric Nephrology: AKI and Thrombotic Microangiopathies in Pregnancy. Clinical Journal of the American Society of Nephrology, 7, 2100-2106.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.