Maternal and Fetal Outcomes and Their Predictors in Renal Dysfunction in Pregnancy

Renal disorders in pregnancy include pregnancy-related acute kidney injury (AKI) and pre-existing chronic kidney disease (CKD), which are risky for both the mother and the fetus. Here, we present the epidemiology and outcomes of pregnancy-related acute kidney injury and CKD in pregnancy at our tertiary care center. We studied the maternal and fetal outcomes of AKI and CKD in pregnancy. Pregnant females and women up to 6 weeks postpartum with AKI or CKD were included in the study; those aged <18 years were excluded. Of 70 cases, 55 had AKI, 10 had AKI and CKD, and 5 had CKD (two were at CKD Stage 5D). The mean age was 27.5 ± 5.4 years, and the mean gestational age was 28.6 ± 8.2 weeks. Sepsis was the most common cause of AKI, followed by pre-eclampsia (21/65). Of the mothers, 48 out of 68 recovered completely (two were already on maintenance hemodialysis), and 10 died. Twenty patients required hemodialysis, nine of whom recovered completely, one progressed to CKD, four became dependent on dialysis, and six died. Regarding the fetal outcomes, 28 were normal-term deliveries, seven were medically terminated, and 35 died. Hypertension, sepsis, metabolic acidosis, raised bilirubin, and the need for hemodialysis were significantly associated with poor maternal outcomes. Raised bilirubin was the only maternal factor significantly associated with poor fetal outcomes. AKI and CKD in pregnancy are associated with higher morbidity and mortality in both the mother and fetus; hence, the focus must be on prevention through regular antenatal checkups.