Clinical Study Of Pregnancy Related Kidney Injury

Background and ObjectiveTo learn the prevalence of pregnancy related kidney injury, their maternal condition andpregnancy outcome. To discuss the relationship and impact of obstetric disease, kidneydisease, serum creatinine and24-hour urine protein on maternal condition and pregnancyoutcome.Methods18589women of Han ethnics hospitalized in Obstetric Department and NephrologyDepartment in Shanghai Jiao Tong University affiliated Sixth People’s Hospital from August2004to January2013were analyzed for pregnancy related kidney injury. The inclusivecriteria in Obstetric Department was women with a history of kidney disease or Scr>=70μmol/L or proteinuria>=0.3g/24-hour before the termination of pregnancy. The inclusivecriteria for onset of kidney disease related to pregnancy was the diagnosis of kidney diseasemade during or after6-month delivery. Clinical data was collected.Results(1) There were15601cases in2008to2013and494of them met the criteria. Therewere2988cases in2004to2007and75of them met the criteria. The prevalence ofpregnancy related kidney injury was3.06%(569/18589).(2) The incidence of kidney injurycaused by obstetric disease was3.07%(390/12710), with the most common reason forpre-eclampsia (88.9%). The incidence of chronic kidney disease women with pregnancy is 0.74%(94/12710), with the most common reason for chronic glomerular nephritis. Theincidence of kidney disease onset related to pregnancy was1.49%(43/2891), with the mostcommon reason for chronic glomerular nephritis and IgA nephropathy in pathology. Theincidence of proceeding to end stage renal disease for pregnancy was0.208%(6/2891).Kidney injury caused by obstetric disease may bring greater effect on kidney than kidneydisease women with pregnancy (with higher maternal blood pressure and proteinuria, lowerbirth weight and higher proportion of pre-term babies, P <0.05).(3) Most women withpregnancy related kidney injury underwent cesarean section (>60%). There proportion ofstillbirth, pre-term and low birth weight babies were higher than normal pregnant women.Neonatal death rate was0.63‰and pare-natal death rate was2.05‰. Their proportion offollow-up was low (9.9%).(4) The prevalence of pregnancy related acute kidney injury was0.083%(13/15698), with the most common reason for post-delivery hemorrhage andpre-eclampsia. Their proportion of adverse pregnancy outcome was high (92.3%), but mostwomen could recover after the termination (84.6%).(5) Our centre took on more rescuework of pregnant women with renal insufficiency after the foundation of Shanghai First-AidCenter for high-risk pregnant woman in2007.(6) In mono-risk factor analysis and logisticanalysis, moderate-severe obstetric disease and increased LDH were risk factors. Area undercurve of ROC of mean arterial blood pressure was the largest.ConclusionsPrevalence of pregnancy related kidney injury increases, deserving attention. Serumcreatinine, proteinuria and blood pressure have different indication for maternal conditionand pregnancy outcome. The concept of ‘Obstetric Nephrology’ will bring some new ideason pregnancy related kidney injury to us.