ABSTRACT Title: A Retrospective Audit of Renal Disease in Pregnancy
Authors: Sammartino C1, Jarvis EM1,2, and Morton A1. Affiliation:
1 Mater Mothers’ Hospital South Brisbane QLD Australia.
2 Metro South Health Logan Hospital Meadowbrook QLD Australia
Abstract Text:
Background:
Kidney disease in pregnancy poses a challenge for management. Acute kidney injury may occur as the result of pregnancy-related conditions, and pre-existing renal dysfunction may result in adverse pregnancy outcomes. We present our findings of 144 women in pregnancy with acute and chronic renal impairment, including 5 women on dialysis and 10 with renal transplants.
Methods:
Mothers with abnormal renal function between 2000 and 2014 were identified retrospectively from the hospital database. Information regarding pre-pregnancy, peri-partum and post-partum renal function and proteinuria was collected where available. Women with renal transplant and those requiring dialysis were identified. Mode of delivery and foetal outcomes including gestation and birthweight were also collected where available.
Results:
Of the cases identified, 87 had an acute kidney injury in pregnancy and 57 were identified as having chronic kidney disease, including 3 on haemodialysis, 2 on peritoneal dialysis in pregnancy (one of these women required additional haemodialysis), 9 patients with renal transplants, 5 patients with liver transplants, and one patient with liver and renal transplants. The majority of cases of acute kidney injury occurred in association with preeclampsia/HELLP spectrum disorders. Where there was pre-existing chronic kidney disease, there was associated increased maternal morbidity with deterioration in baseline renal function and worse foetal morbidity and mortality.
Conclusions:
Renal disease in pregnancy is complex and requires a multidisciplinary team approach to management. Our series represents one of the largest case series of both acute and chronic kidney disease in pregnancy. Similar to developing countries, the most common cause of acute kidney injury was preeclampsia/HELLP spectrum disorders but predictably there was a lower contribution of sepsis/infectious disease. Chronic kidney disease remains an important issue in pregnancy with significant maternal morbidity and risk to the neonate.
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