Pregnancy Complications Linked to History of Acute Kidney Injury

Women with a history of acute kidney injury are at higher risk of adverse pregnancy outcomes such as premature delivery and preeclampsia, finds a new study by investigators at Massachusetts General Hospital (MGH). "Our findings that women with a history of acute kidney injury were at increased risk of complications including preeclampsia are important, because all of these women appeared to have recovered from their kidney injury prior to pregnancy," says Jessica Sheehan Tangren, MD, of the MGH Division of Nephrology, lead and corresponding author of the report.

"They would not necessarily have been identified as at high risk for pregnancy complications," she added.

Link Between Acute Kidney Injury and Pregnancy Complications
Previously conducted studies have linked existing kidney disease to increased risk of pregnancy complications. For the current study, the investigators studied whether a previous episode of acute kidney injury could also increase the risk of pregnancy complications.

The medical records of nearly 25,000 women who delivered babies at the MGH between 1998 and 2007 were analyzed. About 24,640 had no history of kidney disease and 105 women had a history of recovering from acute kidney injury.

The findings showed that women with a history of acute kidney injury were more likely to develop preeclampsia by 23% and cesarean deliveries by 40%. In addition to the higher risk of premature delivery, their babies were small for their gestational age and required intensive care treatment.

After adjusting several influential factors, the history of acute kidney injury increased the risk of preeclampsia by 5.9 times and increased the risk of any adverse fetal outcome by 2.4 times.

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The research team said that the reason behind the increased risk of adverse pregnancy outcome is unclear. But, changes that occur in small blood vessels within the kidneys during recovery from acute kidney injury may compromise the organ’s ability to cope with the demands of pregnancy.

"We know that kidneys undergo major changes during pregnancy, and that sort of 'renal stress test' may reveal previously undetected kidney disease in women with a history of acute kidney injury," says Tangren.

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Jeffrey Ecker, MD, chief of Obstetrics and Gynecology at MGH, said, "Information like this helps obstetric providers know what to be vigilant for in pregnant women with a history of acute kidney injury and indicates that asking about such history is important.”

Looking for signs and symptoms of preeclampsia or any adverse pregnancy complications in patients with a history of acute kidney injury is important.

“Can interventions in patients with a history of acute kidney injury prevent complications like preeclampsia? Taking a baby aspirin each day during pregnancy is recommended for some women at high risk for preeclampsia. Should such preventative treatment be used in women with a history of acute kidney injury? Questions like this deserve further thought and study."

The findings of the study are published online in the Journal of the American Society of Nephrology.

Acute Kidney Injury
Acute kidney injury is a condition in which the kidneys suddenly stop filtering waste from the blood. This condition is more commonly reported in elderly and critically ill patients. It can also occur in young adults hospitalized for conditions such as infections, major injury, trauma, medication side effects or interactions.

Reference:

1. Jessica Sheehan Tangren, Camille E. Powe†, Elizabeth Ankers, Jeffrey Ecker, Kate Bramham§, Michelle A. Hladunewich‖, S. Ananth Karumanchi and Ravi Thadhani. ‘Pregnancy Outcomes after Clinical Recovery from AKI,’ Journal of the American Society of Nephrology:(2016)DOI: 10.1681/ASN.2016070806

Source-Medindia