CHARACTERISTICS AND OUTCOME OF PREGNANCY-RELATED ACUTE KIDNEY INJURY IN A TEACHING HOSPITAL IN A LOW RESOURCE SETTING, DERA ISMAIL KHAN, PAKISTAN

Abstract

Background: Acute Kidney Injury (AKI) is frequently caused by pregnancy-related acute kidney damage (PRAKI), which has a pooled incidence of 2% worldwide.

Objective: To determine the clinical characteristics, associated risk factors, and maternal renal outcomes of pregnancy-related acute kidney injury in patients managed at a low-resource setting in Dera Ismail Khan,Pakistan.

Material and Methods: This cross-sectional study was conducted in the Nephrology Unit of District Headquarter Teaching Hospital, Dera Ismail Khan, Pakistan, from May to September 2025. Using a non-probability consecutive sampling technique, all eligible pregnant or postpartum women diagnosed with acute kidney injury according to KDIGO criteria were enrolled during the study period. Data were analyzed by using IBM SPSS Statistics version 23. Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were presented as frequencies and percentages, n (%). The Chi-square test and Fisher’s exact test were used to assess associations between variables. A p-value <0.05 was considered statistically significant.

Results: A total of 48 postpartum patients with acute kidney injury were included in the study. Multiparous women accounted for 28 (58.3%) cases, while 40 (83.3%) patients were uncooked. Spontaneous vaginal delivery was the most common mode of delivery, occurring in 32 (66.7%) patients. Postpartum haemorrhage was observed in 36 (75%) patients, followed by eclampsia in 20 (41.7%), sepsis in 11 (22.9%), gestational diabetes mellitus in 12 (25%), and hypertensive disorders of pregnancy in 8 (16.7%) patients. Overall, 18 (37.5%) patients achieved renal recovery, whereas 30(62.5%) had poor outcomes. Maternal mortality occurred in 4 (8.3%) patients. Postpartum haemorrhage, sepsis, and eclampsia were significantly associated with poor outcomes.

Conclusion: Pregnancy-related acute kidney injury remains a significant contributor to maternal morbidity in low-resource settings, Poor renal outcome was observed in 30(62.5%) of patients, while 18(37.5%) showed renal recovery. Postpartum hemorrhage (p=0.02), sepsis (p=0.026), and eclampsia (p=0.035) were significantly associated with adverse outcomes.