Evaluate The Incidence And Risk Factors Of Pregnancy Related Acute Kidney Injury By KDIGO Criteria

[Objectives]Investigate the incidence of acute kidney injury (PR-AKI) related to pregnancy with the standard of KDIGO diagnostic,to study the etiology, risk factors and characteristics of PR-AKI; prevent the happening of the PR-AKI in advance and improve survival of pregnant and newborns.[Methods]Review the case data of 2757 pregnant women hospitaled in obstetrics from July to December in 2015,among them 188 patients with different degrees of hematuria,proteinuria and serum creatinine were exceped;24 patients were assigned as PR-AKI group,the other 164 were diagnosed as non AKI with the criteria of KDIGO.Analyze the risk factors associated with PR-AKI by review the case information:Age,prenatal, number, or hypertension of pregnancy,abortion history and other general clinical data,at the same time biochemical indexes (blood uric acid, urea, creatinine) were also included.[Results]1.24 patients were diagnosed as AKI with criteria of KDIGO, account for 8.7‰ of those,41.67% were postpartum hemorrhage,12.50% were mild preeclampsia, 20.83% were severe preeclampsia,8.33% were gestational hypertension,8.33% were stillbirth missed,8.33% were multiple factors (including two and above all these reasons); 79.17% were stage 1 of AKI,16.67% were stage 2 of AKI,4.17% were stage 3 of AKI.2.Statistics shows blood pressure (t=3.686, p<0.001), diastolic blood pressure (t=-2.961,p=0.003), uric acid(t=-3.847, p=0.001), urea (t=-2.403, p=0.017) constitute the difference was statistically significant; By univariable analysis variables analyzed as risk factors included systolic blood pressure(OR=1.048,95%C.I.=1.020-1.077), diastolic blood pressure (OR=1.054,95%C.I.=1.016-1.094), uric acid(OR=1.013, 95%C.I=1.007-1.019), urea(OR=1.294,95%C.I.=1.039-1.612)and CRP(OR=1.011, 95%C.I.=1.000-1.023) is a risk factor for PR-AKI;by multi-univariable analysis uric acid(OR=1.012,95%C.I.=1.006-1.019),CRP(OR=1.015,95%CI=1.002-1.028),systolic blood pressure(OR=1.037,95%C.I.=1.007-1.069) are independent risk factors of PR-AKI.3. PR-AKI group and pregnancy with non AKI fetal adverse pregnancy outcome was statistically difference in case-controls(χ2=5.921,p=0.015).Logistic regression analysis found that AKI is a risk factor of adverse pregnancy outcomes,.the occurance rate of PR-AKI is 2.856 folds of non-PR-AKI (OR= 2.856,95%C.I.=1.196-6.821).4.Stillbirth or neonatal mortality was 16.67% in PR-AKI group,6.1% in non-PR-AKI; there was no statistically significant difference between PR-AKI group and non pregnancy AKI stillbirth or neonatal death (χ2=2.828, p=0.093).[Conclusions]1.The incidence of acute kidney injury related to pregnancy was 8.7 per thousand. 79.17% were stage 1 of AKI,16.67% were stage 2 of AKI,4.17% were stage 3 of AKI; postpartum hemorrhage and pregnancy-induced hypertension were the main etiology of PR-AKI.2. Blood pressure, uric acid, CRP, urea is risk factors of PR-AKI, uric acid, CRP and systolic blood pressure are independent risk factors of PR-AKI.3. AKI is the risk factor of adverse pregnancy outcomes, PR-AKI group fetal or neonatal was 2.856 times of non-AKI in the probability of adverse pregnancy,79.17% were stage 1 of AKI, shows that even mild kidney damage can lead to severe clinical outcomes, great importance should be paid by departments of kidney, obstetric and newborn pediatric attaches. PR-AKI were characterized by complex etiologies andcritical conditions, predict adverse pregnancy outcomes of fetal or neonatal, so early diagnosisand intervention is necessary.