Assessment Of Characteristics Of Patients With Pregnancy Related Acute Kidney Injury In Kenyatta National Hospital

Abstract

Background: Pregnancy Related Acute Kidney Injury(PRAKI) remains a grave complication of pregnancythat is poorly understood. There is paucity of dataon patient characteristics. Studies done are fewand demonstrate great variability in risk factors andoutcome across socio economic boundaries.Objective: To determine the demographic and clinicalcharacteristics of patients with PRAKI at KenyattaNational Hospital (KNH).Methods: A descriptive study was carried on pregnantwomen with gestation age of 28 weeks and above andpostpartum women within six weeks after deliveryadmitted in labour ward or the post natal wards atKNH. Study commenced after approval by the KNHUniversityof Nairobi Ethics and Research Committee.Follow up was until discharge or for a maximum oftwo weeks. Patient management was at the discretionof attending clinician.Results: A total of 66 participants out of 2,068admissions were enrolled into the study. Theprevalence of PRAKI was 3.2%. The mean age was28 years, with peak age between 26-30 years. Fortytwo (63.6%) were referrals, of whom 24 (57.1%) werefrom the rural areas and 18 (42.9%) were from healthfacilities within the City of Nairobi. Nineteen (27.8%)participants had premorbid medical conditions ofwhich cardiovascular diseases, 16 (24.2%) werethe majority. All participants developed singleor overlapping obstetric complications of which,predominantly: preeclampsia 28 (42.4%), eclampsia8 (9.1%) and Haemolysis with Elevated Liver EnzymeLow Platelet (HELLP) syndrome 17 (25.8%). Notedwith volume loss were 9 (13.6%). Average gestationage at delivery was 35 weeks. Preterm births were33 (55%) and fresh still births were 17 (25.8%). Therewas a six fold increase in fresh still births amongparticipants. Severity of PRAKI at presentation wasevenly distributed across stages 1 to 111. Nineteen(28.8%) participants were treated with haemodialysis.The rest were managed conservatively. There was nomaternal mortality reported during the study period.Conclusion and recommendations: The studydemonstrated that the majority 63.6% of theparticipants were referrals mainly from the ruralareas. Hypertensive disorders of pregnancy were themain predisposing factors to PRAKI. Most, 55% ofthe infants were born prematurely of whom 43.5%were fresh still births. Kenyatta National Hospital is areferral facility and the findings of this study may notbe representative of the actual patient characteristicsin Kenya. Therefore, future studies should aim atmulticenter approach to unveil disease burden andpatient characteristics across the country.Key words: PRAKI, KNH, Kenya, Preterm birth, Freshstill birth