Acute kidney injury in patients with eclampsia
Main Article Content
Keywords
Intensive Care in Obstetric, High-Risk, Pregnancy, Acute Kidney Injury, Eclampsia
Abstract
Background: Acute kidney injury is a serious complication of pregnancy whose frequency and adverse effects may be greater in eclampsia.
Objective: To determine the frequency, clinical evolution, treatment and outcome of acute kidney injury in patients with eclampsia.
Method: Observational, cross-sectional, retrospective and analytical study. It included a series of 23 pregnant patients with eclampsia from the intensive care unit. Cases with acute kidney injury (serum creatinine > 1.1 mg/dL) were identified to document their frequency, clinical presentation, laboratory data, need for dialysis and outcome. Descriptive and inferential statistics (Wilcoxon test) were used for the analysis. A p value < 0.05 was significant.
Results: The maternal age was 26.43 ± 5.43 years, with a pregnancy of 34.08 ± 3.04 weeks. Seizures occurred in the prepartum period in 69.56%, postpartum 26.09% and both 4.35%. The pre and post-seizure blood pressure showed differences (systolic 155.22 ± 17.80 mmHg vs. 139.13 ± 20.5 mmHg, p < 0.001; diastolic 97.65 ± 22.91 mmHg vs. 89.22 ± 17.81 mmHg, p = 0.010; mean 114.70 ± 24.21 mmHg vs. 105.60 ± 18.01 mmHg, p = 0.003). Pre-seizures creatinine was 0.95 ± 0.26 mg/dL and post-seizures 1.32 ± 0.37 mg/dL (p < 0.001). The frequency of acute kidney injury pre-seizures was 26.08% (6 cases, creatinine 1.30 ± 0.11 mg/dL) and post-seizures 56.52% (13 cases, creatinine 1.55 ± 0.34 mg/dL) (p = 0.026).
Conclusions: The frequency of acute kidney injury increased after the seizures. The intensive care unit stay was prolonged, but without the need for dialysis and without effects on mortality.
References
1. ACOG Practice Bulletin No. 202:Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019;133:e1- e25. doi:10.1097/AOG.0000000000003018
2. Magee LA, Pels A Helewa M, Rey E, von Dadelszen P;Canadian Hypertensive Disorders of Pregnancy (HDP) Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens. 2014;4:105-45. doi:10.1016/j.preghy. 2014.01.003
3. Guía de Práctica Clínica. Actualización 2017. Prevención, diagnóstico y tratamiento de la preeclampsia en el segundo y tercer nivel de atención. México. Secretaría de Salud;2017. Disponible en:http://www.cenetec-difusion. com/CMGPC/S-020-08/ER.pdf. Consultado 4 Abril 2020.
4. Magann EF, Martin Jr JN. Complicated postpartum preeclampsia-eclampsia. Obstet Gynecol Clin North Am. 1995;22(2):337-56.
5. Chakravarty A, Chakrabarti SD. The neurology of eclampsia:some observations. Neurol India. 2002;50(2):128-35.
6. Abernethy VE, Lieberthal W. Acute renal failure in the critically ill patient. Crit Care Clin. 2002;18(2):203-22. doi:10.1016/S0749-0704(01)00002-1
7. Sutton TA, Fisher CL, Molitoris BA. Microvascular endothelial injury and dysfunction during ischemic acute renal failure. Kidney Int. 2002;62(5):1539-49.
8. Purkenson ML, Verdi L. A history of eclampsia, toxemia and kidney in pregnancy. Am J Nephrol. 1999;19(2):313- 9. doi:10.1159/000013467
9. Drakeley AJ, Le Roux PA, Anthony J, Penny J. Acute renal failure complicating severe preeclampsia requiring admission to an obstetric Intensive Care Unit. Am J Obstet Gynecol. 2002;186(2):253-6. doi:10.1067/ mob.2002.120279
10. Orozco-Méndez H, Hernández-Pacheco JA, Estrada-Altamirano A, Hernández Muñóz VA, Carvajal-Valencia AJ, Coronado-Mestre RE. Incidencia y evolución de insuficiencia renal aguda en mujeres con preeclampsia severa y eclampsia en una unidad de cuidados intensivos. Perinatol Reprod Hum. 2011;25(2):67-73.
11. Guerrero HA, Briones-Vega CG, Díaz de León Ponce M, Briones-Garduño JC. Cuidados intensivos en ginecología y obstetricia en el Hospital General de México. Rev Asoc Mex Med Crit Ter Int. 2011;25(4):211-7.
12. Vázquez-Rodríguez JG, Solís-Castillo LA, Cruz-Martínez FJ. Frecuencia y evolución clínica de la insuficiencia renal aguda en pacientes obstétricas tratadas en la unidad de cuidados intensivos de un hospital de alta especialidad en la ciudad de México. Med Intensiva. 2017;41(4):255-7. doi:10.1016/j.medin.2016.03.006
13. Vázquez-Rodríguez JG, Rico-Trejo EI. Complicaciones maternas en pacientes con preeclampsia e hiperuricemia tratadas en la unidad de cuidados intensivos. Ginecol Obstet Mex. 2016;84(03):143-9.
14. Vázquez-Rodríguez JG, Aguilera-Maldonado LV. Aclaramiento de la creatinina en pacientes preeclámpticas con síndrome HELLP. Clin Invest Gin Obstet. 2018;45(3):114- 20. doi:10.1016/j.gine.2017.01.001
15. Mjahed K, Alaoui Y, Barrou L. Acute renal failure during eclampsia:incidence risks factors and outcome in intensive care unit. Renal Failure. 2004;26(3):215-21. doi:10.1081/JDI-120039518
16. Aggarwal RS, Mishra VV, Jasani AF, Gumber M. Acute renal failure in pregnancy:our experience. Saudi J Kidney Dis Transpl. 2014;25(2):450-5.
17. Rodríguez-López M, Roglan-Piqueras A. Diagnóstico precoz del fracaso renal agudo. Med Intensiva. 2010;34(5):291-3. doi:10.1016/j.medin.2010.04.007
18. Liu S, Joseph KS, Liston RM, Bartholomeu S, Walker M, León JA, et al. Incidence, risk factors, and associated complications of eclampsia. Obstet Gynecol. 2011;118(5):987- 94. doi:10.1097/AOG.0b013e31823311c1
19. Bentata Y, Housni B, Mimouini A, Azzouzi A, Abouqal R. Acute kidney injury related to pregnancy in developing countries:etiology and risk factors in an intensive care unit. J Nephrol. 2012;25(5):764-75. doi:10.5301/jn.5000058
20. Collantes-Cubas JA, Vigil-De Gracia P, Benza-Bedoya A, Mendo-Aguilar JA, Pérez-Ventura A, Vigo-Varela S. Eclampsia y síndrome HELLP en los Andes del Perú:complicaciones perinatales. Ginecol Obst Mex. 2018;86(11):718-23. doi:10.24245/gom.v86i11.2266
21. Prakash J, Niwas SS, Parekh A, Pandey LK, Sharatchandra L, Arora P. Acute kidney injury in late pregnancy in developing countries. Renal Failure. 2010;32:309-13. doi:10.3109/08↚21003606265
22. Bernasko J, Álvarez M. Acute renal failure in the obstetric intensive care patient. En:Foley MR, Strong TH Jr, editores. Obstetric intensive care:a practical manual. Philadelphia, USA:WB Saunders Company;1997. p.189.