背景:当怀孕期间发生急性肾损伤时,这是一个棘手的临床问题。孕产妇和胎儿发病和死亡的主要原因之一是妊娠相关急性肾损伤(AKI),一种重要的产科并发症,其特征是肾功能迅速恶化以及随后的一些临床问题。这项研究的目的是分析病因,临床表现,以及妊娠期AKI的母婴结局。
方法:这项前瞻性观察性研究涉及英迪拉·甘地医学科学研究所普通医学和妇产科住院的患者,巴特那,一年(2021年10月至2022年9月)由于产科困难导致急性肾损害。
结果:该研究包括62名患者,平均年龄为25.08±4.25岁。我们研究的大多数患者年龄在18-25岁(38,61.3%),其次是26-30年(19,30.6%)和>30年(5,8.1%)。在我们的研究中,大多数患者是未预订的(52,83.9%),并呈现为急诊病例。而10例(16.1%)患者已预订。此外,34例(54.8%)患者为初产妇,28例(45.1%)为多胎。有25例患者处于妊娠晚期(40.3%),产后19人(30.6%),10人堕胎后(16.1%),和八个在他们的第二个三个月(12.9%)。一被录取,大多数患者表现出少尿的迹象,占45例(72.6%)。其次是9例肾功能异常(14.5%)和8例无尿(12.9%)。在其他症状中,25例(40.32%)发热,而呼吸困难增加到15例(24.19%),水肿14例(22.58%),4例(6.45%)出现呕吐和感觉改变,3例(4.83%)出现腹痛,2例(3.22%)出现排尿灼热。本研究中妊娠期AKI最常见的原因是产褥期败血症(18例,29.0%),其次是先兆子痫/子痫(14例,22.6%),出血性休克(10例,16.1%),败血症流产(6例,9.7%),妊娠剧吐(4例,6.5%),妊娠急性脂肪肝(三例,4.8%),弥散性血管内凝血(3例,4.8%),药物诱导的脓毒症(2例,3.2%),和尿脓毒血症(两例,3.2%)。本研究的分娩方式为正常阴道分娩(32例,51.6%),下段剖宫产术(21例,33.9%),扩张和疏散(7例,11.3%),全子宫切除术(2例,3.2%)。39例(62.9%)患者进行了血液透析,51例(82.3%)接受输血。平均收缩压和舒张压(mmHg)分别为111.37±22.60和71.40±18.88。产妇结局数据显示,48名(77.4%)妇女完全康复,八人(12.9%)尚未康复,43例(69.4%)失访,2人(3.2%)死亡。本研究的新生儿结局如下:活产,43(69.4%);堕胎,八(12.9%);胎儿宫内死亡,五人(8.1%);新生儿死亡率,六(9.7%)。
结论:由于妊娠期间发生的病理生理变化,妊娠期间AKI的诊断和治疗对治疗医生来说是一个重大挑战,症状的变异性,以及临床和实验室特征可能偶尔重叠的事实。
BACKGROUND: When acute kidney damage occurs during pregnancy, it poses a difficult clinical problem. One of the main causes of maternal and fetal morbidity and death is pregnancy-related acute kidney injury (AKI), a significant obstetric complication characterized by a fast deterioration in renal function and several subsequent clinical problems. The objective of the study is to analyze the etiological factors, clinical manifestations, and maternal and fetal outcomes of AKI during pregnancy.
METHODS: This prospective observational research involved patients hospitalized in the General Medicine and Obstetrics and Gynecology departments at Indira Gandhi Institute of Medical Sciences, Patna, for a year (October 2021 to September 2022) due to obstetric difficulties resulting in acute renal damage.
RESULTS: The study included 62 patients with a mean age of 25.08±4.25 years. The majority of patients in our study were aged 18-25 years (38, 61.3%), followed by 26-30 years (19, 30.6%) and >30 years (5, 8.1%). The majority of patients in our study were non-booked (52, 83.9%) and presented as emergency cases, whereas 10 (16.1%) patients had booked. In addition, 34 (54.8%) patients were primigravida, while 28 (45.1%) were multigravida. There were 25 patients in their third trimester (40.3%), 19 who were postpartum (30.6%), 10 who were post-abortion (16.1%), and eight in their second trimester (12.9%). Upon admission, the majority of the patients showed signs of oliguria, accounting for 45 cases (72.6%). This was followed by nine cases of abnormal kidney function (14.5%) and eight cases of anuria (12.9%). Among the other symptoms, fever was observed in 25 cases (40.32%), whereas breathlessness increased to 15 cases (24.19%), edema was present in 14 cases (22.58%), vomiting and altered sensorium were observed in four cases (6.45%), abdominal pain was observed in three cases (4.83%), and burning micturition was observed in two cases (3.22%). The most common causes of AKI in pregnancy in the present study were puerperal sepsis (18 cases, 29.0%), followed by preeclampsia/eclampsia (14 cases, 22.6%), hemorrhagic shock (10 cases, 16.1%), septic abortion (six cases, 9.7%), hyperemesis gravidarum (four cases, 6.5%), acute fatty liver of pregnancy (three cases, 4.8%), disseminated intravascular coagulation (three cases, 4.8%), drug-induced sepsis (two cases, 3.2%), and urosepsis (two cases, 3.2%). Modes of delivery in this study were normal vaginal delivery (32 cases, 51.6%), lower segment cesarean section (21 cases, 33.9%), dilation and evacuation (seven cases, 11.3%), and total hysterectomy (two cases, 3.2%). Hemodialysis was performed in 39 patients (62.9%), and 51 (82.3%) received blood transfusions. The mean systolic and diastolic BP (mmHg) were 111.37±22.60 and 71.40±18.88, respectively. Maternal outcome data revealed that 48 (77.4%) women had fully recovered, eight (12.9%) had not recovered, 43 (69.4%) were lost to follow-up, and two (3.2%) had died. Neonatal outcomes in the present study were as follows: live birth, 43 (69.4%); abortion, eight (12.9%); intrauterine death of the fetus, five (8.1%); and neonatal mortality, six (9.7%).
CONCLUSIONS: The diagnosis and treatment of AKI during pregnancy is a significant challenge for the treating physician because of the pathophysiological changes that occur during pregnancy, the variability of symptoms, and the fact that clinical and laboratory features may occasionally overlap.