Epidemiology and Maternal-Fetal Outcomes of Pregnancy-Related Acute Kidney Injury: A Prospective Observational Study of a Predominantly Dialysis-Requiring Cohort at a Tertiary Care Center in Northern India.

backgroundPregnancy-associated acute kidney injury (PRAKI) is a significant cause of maternal morbidity and mortality, particularly in low- to middle-income countries like India. The majority of patients with stage 1/2 acute kidney injury (AKI) recover without any long-term sequelae; however, the scenario changes completely when the patients are found to be dialysis-requiring. Fixed decline in glomerular filtration rate and progression to end-stage renal disease/long-term dialysis requirement can occur in the latter group of patients, posing significant health challenges and a burden to society. We tend to investigate this group of patients with short-term follow-up for renal outcomes. MATERIALS AND

methodsThis is a single-center study at a tertiary care center in northern India. We prospectively studied patients with PRAKI regarding their clinical presentation and maternal and fetal outcomes, with follow-up for three months post-discharge. Sixty-six pregnant patients with a diagnosis of AKI were admitted to our institution from 2023 to 2025. A total of 58 patients were analyzed. Maternal and fetal outcomes were noted, and patients were followed up at one month and three months post-discharge. Maternal outcomes included in-hospital mortality, complete recovery (serum creatinine <1.4 mg/dL), chronic kidney disease (CKD), and dialysis dependency at three months.

resultsThe mean age was 27 years, with 79% aged 20-30 years and 41% primigravida. Puerperal sepsis (62.1%) was the leading cause, followed by septic abortion (15.5%) and antepartum hemorrhage (APH) and/or postpartum hemorrhage (PPH). Anuria (64%) was the most common presentation. Cesarean section occurred in 65% of cases, and 72% of AKIs were diagnosed postpartum. Complications included disseminated intravascular coagulation (DIC) and multi-organ dysfunction syndrome (MODS) in 28 patients. Fetal outcomes showed 48.3% preterm deliveries and 20.7% intra-uterine deaths (IUD)/stillbirths. Maternal outcomes included 41.4% renal recovery by three months, 27.6% mortality (20.7% in-hospital), and 31.1% progression to CKD, with 5.2% dialysis-dependent. Biopsies (15.5% of cases) revealed patchy cortical necrosis (five patients), IgA nephropathy (three patients), and Alport syndrome (one patient). Intensive care unit (ICU) stay, higher total leukocyte count, elevated serum glutamic oxaloacetic transaminase (SGOT) levels, and prolonged prothrombin time/international normalized ratio (PT/INR) were associated with maternal mortality. Dialysis dependency at discharge predicted adverse renal outcomes at three months.

conclusionDialysis-requiring PRAKI is associated with high maternal mortality, fetal morbidity, and significant progression to CKD/end-stage renal disease. Puerperal sepsis remains the commonest cause, followed by septic abortion. Early sepsis management could reduce morbidity. The study underscores the need for improved obstetric care and timely intervention in resource-limited settings to mitigate the impact of PRAKI on maternal and fetal health.