Transcript Questions to be answered - London Acute Kidney Injury Network

Acute Kidney Injury in Pregnancy;
experience from a Large Tertiary Care Referral Centre
Alexandra Mihalache, Oier Ateka, Inês Palma Reis, Kate Harding, Catherine Nelson-Piercy, Anita Banerjee
Women’s Health Directorate, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, England, UK
AKI population
Background
•AKIN classification is not validated in
pregnancy
•Creatinine is known to fall in pregnancy
•Creatinine rise >90mmol/L has been
shown to be indicative of renal
impairment in pregnancy
Questions to be answered
•What is the incidence of AKI in our
obstetric unit?
•What are the common causes of AKI in
pregnancy?
•How is AKI managed on the obstetric
unit?
Age (Years) Mean (Range)
BMI (Kg/m2) Mean (SD)
Gestation (Weeks)
General
population
32.8 (22-46)
21 (16-59)
26.29 ±4.96
24.6 ±5.4
37.6
38.9
B
A
Table I Demographics, 19% had chronic kidney disease
causes of AKI in pregnancy
Trimester of AKI presentation
3rd trimester
Postpartum
AKI recognised and
documented in medical notes
Review of drug chart on
recognition of AKI
Peak creatinine (mmol/L)
Peak Potassium (mmol/L)
Cause
60%
40%
45%
D
C
17%
D
111.9 (90-263)
4.87 (4-7)
No of
patients
Pre-eclampsia (PET)
Post partum haemorrhage(PPH)
Drugs [NSAIDS/ACE inhibitors]
Pre-renal
Acute Fatty Liver of Pregnancy
61
27
10
22
1
(AFLP)
Unknown
5
Table II The characteristics of the AKI population
Table IV: Common causes of AKI in pregnancy
Complete Recovery
Partial Recovery
Unknown-no documentation
Summary
•The incidence of AKI is 1.4% in our
obstetric unit
•Common causes of AKI: PET & PPH
•AKI was recognised in <50% cases
•Not all AKI had improved prior to
discharge
Conclusion More understanding of AKI
in obstetric units is required
Methodology
•2011 retrospective data collection of
deliveries at St Thomas’ Hospital
•Through pathology system all cases with
creatinine >90mmol/L identified
•Data collection through review of
medical notes
•95 collected notes from 6518 deliveries
PET
PPH
DRUGS
Pre-renal
AFLD
Unknown
60%
24%
16%
Table III The renal function recovery at discharge in this population