Outcome of Acute Kidney Injury in Pregnancy in N’Djamena, Chad

Abstract

Introduction: Acute kidney injury (AKI) is a relatively rare but serious complication during pregnancy. It is often the consequence of a delay or poor management of a given complication that constitutes as a public health problem in developing countries. The objective of our study was to determine the epidemiological, diagnostic, therapeutic and evolutionary aspects of obstetric acute kidney injury in Chad. Methodology: This was a cross-sectional study with descriptive and analytical aims over a period of 6 months from June 1, 2020 to November 30, 2020 and conducted in the Gyneco-Obstetric Emergency Department of the Mother and Child University Hospital in N’Djamena. All patients admitted for obstetric AKI and requiring hemodialysis were referred to the Nephrology Department of the Renaissance University Hospital. AKI was defined according to the KDIGO 2012 classification. All pregnant women with more than 20 weeks of gestation until immediately postpartum who were admitted for acute kidney injury were included in the study. Results: During our work, 1238 patients were collected. Among them, 56 cases of obstetric AKI were included, representing a hospital prevalence of 4.5%. The average age was 26.1 ± 5.8 years (16 and 37 years). The majority of our patients were primigravidas which was 42%, rural women represented 35.7% of our sample and nearly 67.8% of pregnancies did not benefit from regular prenatal consultation. AKI during the 3rd trimester was found in 42.9% of cases. Oligo-anuria was present in 28.6% of cases. Acute tubular necrosis was found in 52 cases. It was secondary to preeclampsia in 60.7%, to HELLP syndrome in 17.9% and to a hemorrhagic delivery complicating a retroplacental hematoma in 7.1%. According to the KDIGO 2012 classification, Stages 1, 2 and 3 represented 32%, 23% and 25% of cases, respectively. Hemodialysis was initiated in 1/4 of cases. Recovery of renal function was complete in 78.6% of cases and partial in 7.1%. We recorded eight (14.3%) maternal deaths and twenty-four cases of in-utero fetal death. The average length of hospital stay was 9.21 ± 5 days (2 and 20 days). Conclusion: Obstetric AKI remains a serious complication of pregnancy and postpartum. Despite the good renal prognosis, severe preeclampsia is the main cause. Prevention through monitoring pregnancies would be the most effective measure.