Related Experiment Video
Updated: Aug 8, 2025
Noninvasive and Invasive Renal Hypoxia Monitoring in a Porcine Model of Hemorrhagic Shock
Published on: October 28, 2022
Etiology of Pregnancy-related Acute Kidney Injury among Obstetric Patients in India: A Systematic Review
Medhavi Gautam1, Sulekha Saxena2, Sai Saran2
1Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
Insights
Pregnancy-related acute kidney injury (PRAKI) in India is most commonly caused by sepsis, followed by hemorrhage and pregnancy-induced hypertension. This systematic review highlights the need for standardized reporting to understand PRAKI
Area of Science:
- Nephrology
- Obstetrics
- Public Health
Background:
- Pregnancy-related acute kidney injury (PRAKI) is a significant contributor to maternal mortality and morbidity, particularly in developing nations.
- Identifying the specific causes of PRAKI is crucial for implementing effective prevention and management strategies.
Purpose of the Study:
- To systematically review and identify the primary etiological factors of PRAKI among obstetric patients in India.
- To synthesize evidence on the prevalence of different causes of PRAKI in the Indian obstetric population.
Main Methods:
- A systematic literature search was conducted across PubMed, MEDLINE, Embase, and Google Scholar from January 2010 to December 2021.
- Included studies focused on the etiology of PRAKI in Indian obstetric patients, excluding studies from other regions or specific subgroups.
- Risk of bias was assessed using a five-point questionnaire, and results were synthesized following PRISMA guidelines.
Main Results:
- Seven studies involving 477 participants were analyzed, all being single-center observational studies.
- Sepsis emerged as the most frequent cause of PRAKI (mean 41.9%), followed by hemorrhage (mean 22.1%) and pregnancy-induced hypertension (mean 20.9%).
- The quality of evidence was predominantly moderate, with limitations due to the lack of a consensus definition for PRAKI and heterogeneous reporting methods.
Conclusions:
- Moderate quality evidence indicates that sepsis, hemorrhage, and pregnancy-induced hypertension are the leading causes of PRAKI in India.
- The findings underscore the necessity for a structured reporting format for PRAKI to accurately ascertain disease burden and guide public health interventions.
Background:
Pregnancy-related acute kidney injury (PRAKI) is an important cause of fetomaternal mortality and morbidity in developing countries. We undertook a systematic review to identify the causes of PRAKI among obstetric patients in India.
Materials And Methods:
We systematically searched PubMed, MEDLINE, Embase, and Google Scholar using appropriate search terminology between 1 January 2010 to 31 December 2021. Studies reporting the etiology of PRAKI among obstetric patients (pregnant and within 42 days postpartum) in India were included for evaluation. Studies done in any other geographical location besides India were excluded. We also excluded studies done in any one trimester or any specific subgroup of patients [e.g., postpartum acute kidney injury (AKI), postabortal AKI]. A five-point questionnaire was used to assess the risk of bias in included studies. The results were synthesized as per preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.
Results:
A total number of 7 studies with 477 participants were included for analysis. All were single-center descriptive observational studies either done in tertiary care public or private hospitals. Sepsis (mean, 41.9%; median, 49.4%; and range, 6-56.1%) was the most common cause of PRAKI followed by hemorrhage (mean, 22.1%; median, 23.5%; and range, 8.3-38.5%) and pregnancy-induced hypertension (mean, 20.9%; median, 20.7; and range, 11.5-39%). Among these seven studies, five were of moderate quality, one was of high quality, and another one was of low quality. Our study is limited due to the lack of consensus definition of PRAKI in literature and heterogeneity in reporting methods. Our study highlights the need for a structured reporting format for PRAKI to understand the true disease burden and take control measures.
Conclusion:
There is a moderate quality of evidence to suggest that sepsis followed by hemorrhage and pregnancy-induced hypertension are the commonest causes of PRAKI in India.
How To Cite This Article:
Gautam M, Saxena S, Saran S, Ahmed A, Pandey A, Mishra P, et al. Etiology of Pregnancy-related Acute Kidney Injury among Obstetric Patients in India: A Systematic Review. Indian J Crit Care Med 2022;26(10):1141-1151.
Related Concept Videos
01:29Acute Kidney Injury II: Pathophysiology
01:22Acute Kidney Injury I: Introduction
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:29Acute Kidney Injury III: Clinical Manifestations
01:27Acute Pyelonephritis I: Introduction
01:20Acute Kidney Injury V: Interprofessional Care