Clinical Study Of Single Center Pregnancy-related Renal Injury

Objective:To study the proportion of pregnancy-related kidney injury,the maternal condition and pregnancy outcome of pregnancy-related kidney injury,and the influence of serum creatinine and 24-hour urinary protein on pregnancy outcome.Methods:A retrospective study was conducted to analyze 27 511 pregnant women hospitalized in obstetrics from September 2008 to September 2018.The selection criteria were as follows:1.Before termination of pregnancy in obstetric patients during hospitalization,serum creatinine>70μmol/L and/or 24-hour urinary protein quantification>0.3g/24h.Exclusion criteria:1.Serum creatinine<70μmol/L and 24-hour urinary protein<0.3g/24h before termination of pregnancy during hospitalization;2.Although serum creatinine>70μmol/L and/or 24-hour urinary protein>0.3g/24h,pregnancy endpoints can not be observed,or women who voluntarily terminate pregnancy in the early and middle stages of pregnancy.Through the hospital "Intelligent Platform for Medical Data" and through ethical review,the clinical information of 1348 obstetric patients who met the criteria of admission and exclusion from September 2008 to September 2018 was analyzed,screened and derived,and a unified questionnaire was designed.The contents of the exportation include:the general situation and medical history of patients:age,nationality,gestational age,kidney disease history,hospitalization days;maternal condition blood pressure,hemoglobin,platelet,albumin,serum creatinine,urea,uric acid,24-hour urine protein quantification;pregnancy outcome:mode of delivery(cesarean section or not),birth weight of newborns.Preliminary descriptive analysis of maternal status and pregnancy outcomes.According to the pregnancy outcome,it was divided into two groups:ideal pregnancy outcome and adverse pregnancy outcome.The risk factors affecting adverse pregnancy outcome were analyzed.Results:(1)From September 2008 to September 2018,a total of 27511 cases were collected,of which 1348 were cases,and the incidence of pregnancy-related kidney injury was 4.90%(1348/27511).The average age was 34±5 years,ranging from 21 to 49 years.Ethnic distribution:1133 people of Han nationality,accounting for 84.05%;169 people of Mongolian nationality,accounting for 12.54%;46 people of other nationalities,including Manchu and Hui,accounting for 3.41%.The average gestational week was 3 6±3 weeks,and 1323 people were in the third trimester of pregnancy,accounting for 98.14%.Twenty people had a history of kidney disease in the past,accounting for 1.48%.The average length of stay was 7±4 days.Most of them had cesarean section,which accounted for 85.01%.(2)In the single risk factor analysis,the OR values of PLT<100*109/L,ALB<30g/L,LDH>618U/L,MAP>105mmHg,renal function damage,proteinuria and quantitative urinary protein≥3g/24h were>1(P<0.05).In logistic regression analysis,LDH>618U/L,MAP>105mmHg,renal function damage,proteinuria and quantitative urinary protein≥3g/24h were risk factors for adverse pregnancy outcomes(P<0.05).(3)Neonatal birth weight was correlated with maternal biochemical indicators.Neonatal birth weight was negatively correlated with gestational weeks,hemoglobin,platelets,albumin,mean arterial pressure,LDH and 24-hour urinary protein,and negatively correlated with hemoglobin,mean arterial pressure,LDH and 24-hour urinary protein.The correlation coefficient with gestational weeks was the largest,and the correlation coefficient with platelets was the smallest.(4)Drawing ROC curve of maternal indicators of pregnancy outcome.The area under the LDH curve is the largest and the area under the blood urea curve is the smallest.Conclusions:1.The incidence of pregnancy-related kidney injury in the center is 4.90%.Clinically,pregnancy-related kidney injury is not uncommon and deserves attention.2.Risk factors analysis showed that LDH>618U/L,MAP>105mmHg,renal function damage,proteinuria and quantitative urinary protein≥3g/24h were risk factors for adverse pregnancy outcomes.3.The birth weight of neonates was quantitatively correlated with gestational weeks,hemoglobin,platelets,albumin,mean arterial pressure,LDH and 24 hours.4.Draw ROC curve which reflects maternal indicators of pregnancy outcome,and the area under LDH curve is the largest.5.In the patients with pregnancy-related kidney injury,there are many factors affecting pregnancy outcomes.Clinically,creatinine and 24-hour urinary protein quantification can prompt pregnancy outcomes,but pregnancy outcomes can not be well judged only by serum creatinine level or 24-hour urinary protein quantification level.In clinical work,it is necessary to fully understand the patient’s condition and combine the two factors.The indicators are judged comprehensively.