بررسی فراوانی و علل نارسایی حاد کلیه در بارداری با توجه به مشکلات مربوط به بارداری: مطالعه تک‌مرکز

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه داخلی نفرولو‌ژی، دانشکده پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

2 پزشک عمومی، دانشکده پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

3 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

چکیده

مقدمه: شیوع نارسایی حاد کلیه در دوران بارداری، در کشورهای مختلف متفاوت است. هرچند وقوع آن طی سال‌های اخیر کاهش یافته است، ولی یکی از علل مهم مرگ‌ومیر مادران باردار می‌باشد. با توجه به این که در استان سیستان و بلوچستان در این زمینه آماری دقیقی وجود ندارد، مطالعه حاضر با هدف بررسی شیوع نارسایی حاد کلیه و علل بروز آن در زنان باردار مراجعه‌کننده به بیمارستان علی‌بن ‌ابیطالب زاهدان انجام شد.
روش‌کار: این مطالعه توصیفی- مقطعی و گذشته‌نگر بر روی پرونده ۱۵۳۹۷ زن باردار مراجعه‌کننده به بیمارستان علی‌ابن ابیطالب زاهدان در سال‌های ۹۷-۱۳۹۶ انجام شد. پرونده بیمارانی که کراتینین حداقل ۲ نوبت بالاتر از ۸۷/۰ و یا اولیگوآنوری بیشتر از ۱۲ ساعت داشتند، مورد بررسی قرار گرفت. از این تعداد، ۳۱۸ مورد با تشخیص نارسایی حاد کلیه وارد بررسی شدند و علل مختلف نارسایی حاد کلیه در بارداری مورد مطالعه قرار گرفت. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 20) و آزمون‌های تی دانشجویی و من‌ویتنی انجام شد. میزان p‌ کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: از ۱۵۳۹۷ تولد زنده طی مدت 1 سال، ۳۱۸ مورد (۰۶۵/۲%) نارسایی کلیه و ۳۹ بیمار (۲۶/۱۲%) نیاز به دیالیز داشتند و ۲۰ مورد (۲۸/۶%) مرگ مادر گزارش شده بود. شایع‌ترین علل نارسایی حاد کلیه به‌ترتیب پره‌اکلامپسی (۳۴%)، سپسیس (۶/۱۸%) و شوک هموراژا‌یک (۸/۱۳%) بود.
نتیجه‌گیری: نارسایی حاد کلیه در مادران باردار بیمارستان علی‌ابن ابیطالب زاهدان شیوع بالایی دارد. مهم‌ترین آن پره‌اکلامپسی، سپسیس و شوک هموراژیک بود و در این بین، درصد قابل ملاحظه‌ای نیاز به دیالیز داشته و مرگ مادران باردار نیز نسبتاً بالا است. با توجه به نرخ بالای زادوولد در این استان و خطر نارسایی حاد کلیه، افزایش کنترل بهداشتی زنان باردار باید با دقت و توجه بیشتری انجام شود.

کلیدواژه‌ها


عنوان مقاله [English]

Causes and prevalence of acute kidney injury in pregnancy regarding to pregnancy-related problems: single-center study

نویسندگان [English]

  • Elham Shahreki 1
  • Somayeh Kordi Todzil 2
  • Batool Teimoori 3
1 Assistant professor, Department of Nephrology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
2 General Physician, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
3 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
چکیده [English]

Introduction: The prevalence of acute renal failure during pregnancy varies from country to country. Although the prevalence of acute kidney injury (AKI) during pregnancy has decreased in recent years, it is still one of the most leading causes of mortality in pregnant women. Due to the lack of accurate data in this field in Sistan and Baluchestan province, this study was performed aimed to investigate the causes and prevalence of AKI in pregnant women referred to Ali Ibn Abitaleb Hospital in Zahedan.
Methods: This cross-sectional descriptive and retrospective study was performed on 15397 files of pregnant women referred to Ali Ibn Abitaleb Hospital in Zahedan in 2017-2018. The files of patients with at least 2 times of creatinine higher than 0.87 and/or oligoanuria longer than 12 hours were evaluated. Among them, 318 cases diagnosed with AKI entered the study; meanwhile, various causes of AKI in pregnancy were studied. Data were analyzed using SPSS software (version 20) and student t-test and Mann-Whitney test. P<0.05 was considered statistically significant.
Results: Among 15397 live births during one year, 318 cases of AKI (2.065%) and 39 patients (12.26%) required dialysis; in addition, 20 (6.28%) cases of death were reported. The most common causes of renal failure were preeclampsia (34%), sepsis (18.6%) and hemorrhagic shock (13.8%).
Conclusion: The prevalence of AKI in pregnant women in Ali Ibn Abitaleb Hospital of Zahedan was high. The most important causes were preeclampsia, sepsis and hemorrhagic shock and a significant number of them needed dialysis. The maternal mortality rate was also relatively high. Due to the high rate of birth in this province and the risk of AKI, health control of pregnant women should be performed with more accuracy and attention.

کلیدواژه‌ها [English]

  • Acute renal failure
  • Maternal Death
  • Preeclampsia
  • pregnancy
  1. He L, Wei Q, Liu J, Yi M, Liu Y, Liu H, et al. AKI on CKD: heightened injury, suppressed repair, and the underlying mechanisms. Kidney International 2017; 92(5):1071-83.
  2. Suarez ML, Kattah A, Grande JP, Garovic V. Renal disorders in pregnancy: Core curriculum 2019. American Journal of Kidney Diseases 2019; 73(1):119-30.
  3. Prakash J, Kumar H, Sinha DK, Kedalaya PG, Pandey LK, Srivastava PK, et al. Acute renal failure in pregnancy in a developing country: twenty years of experience. Renal failure 2006; 28(4):309-13.
  4. Godara SM, Kute VB, Trivedi HL, Vanikar AV, Shah PR, Gumber MR, et al. Clinical profile and outcome of acute kidney injury related to pregnancy in developing countries: a single-center study from India. Saudi Journal of Kidney Diseases and Transplantation 2014; 25(4):906-11.
  5. Prakash J, Ganiger VC, Prakash S, Iqbal M, Kar DP, Singh U, et al. Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014–2016). Journal of nephrology 2018; 31(1):79-85.
  6. Bentata Y, Housni B, Mimouni A, Azzouzi A, Abouqal R. Acute kidney injury related to pregnancy in developing countries: etiology and risk factors in an intensive care unit. Journal of nephrology 2012; 25(5):764-75.
  7. Negi S, Koreeda D, Kobayashi S, Yano T, Tatsuta K, Mima T, et al. Acute kidney injury: Epidemiology, outcomes, complications, and therapeutic strategies. InSeminars in dialysis 2018; 31(5):519-27.
  8. Huang C, Chen S. Acute kidney injury during pregnancy and puerperium: a retrospective study in a single center. BMC nephrology 2017; 18(1):1-9.
  9. Rashid H, Akram M, Malik MB. Acute renal failure in pregnancy, its causes and outcome, 1 year study at Shaikh Zayed Hospital Lahore. Annals of King Edward Medical University 2013; 19(1):33-.
  10. Mohammadinia N, Samiezadeh Toosi T, Rezaei MA, Rostaei F. Investigating the frequency and effective factors on maternal mortality in Sistan and Baluchistan Province, Iran, 2002-2009. Iran J Obstet Gynecol Infertil 2013; 16(44):28-34.
  11. Piccoli GB, Zakharova E, Attini R, Ibarra Hernandez M, Covella B, Alrukhaimi M, et al. Acute kidney injury in pregnancy: the need for higher awareness. A pragmatic review focused on what could be improved in the prevention and care of pregnancy-related AKI, in the year dedicated to women and kidney diseases. Journal of clinical medicine 2018; 7(10):318.
  12. Diesase K. Improving global outcomes (KDIGO) acute kidney injury work group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2(1):1-38.
  13. Krane NK, Hamrahian M. Pregnancy: kidney diseases and hypertension. American Journal of Kidney Diseases 2007; 49(2):336-45.
  14. Espinoza J, Vidaeff A, Pettker CM, Simhan H. Gestational Hypertension and Preeclampsia. Obstetrics and Gynecology 2020; 135(6):E237-60.
  15. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension 2018; 72(1):24-43.
  16. Karimi Z, Malekmakan L, Farshadi M. The prevalence of pregnancy-related acute renal failure in Asia: A systematic review. Saudi Journal of Kidney Diseases and Transplantation 2017; 28(1):1.
  17. Liu YM, Hong DB, Jiang ZZ, Huang YJ, Wang NS. Pregnancy-related acute kidney injury and a review of the literature in China. Internal Medicine 2015; 54(14):1695-703.
  18. Cooke WR, Hemmilä UK, Craik AL, Mandula CJ, Mvula P, Msusa A, et al. Incidence, aetiology and outcomes of obstetric-related acute kidney injury in Malawi: a prospective observational study. BMC nephrology 2018; 19(1):1-8.
  19. Mehrabadi A, Liu S, Bartholomew S, Hutcheon JA, Magee LA, Kramer MS, et al. Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada: population based retrospective cohort study. Bmj 2014; 349.
  20. Szczepanski J, Griffin A, Novotny S, Wallace K. Acute kidney injury in pregnancies complicated with preeclampsia or HELLP syndrome. Frontiers in medicine 2020; 7:22.
  21. Aghabozorgi M, torkestani F, Jouhari Z. Prevalence and causes of severe maternal complications and near-death mothers in Shahid Mostafa Khomeini Hospital: 2015-2016. Iran J Obstet Gynecol Infertil 2021.
  22. Peng DZ. Acute renal failure in severe pregnancy induced hypertension: a report of 19 cases. Zhonghua fu Chan ke za zhi 1993; 28(5):281-3.
  23. Abdollahpour A, Doustmohammadi H, Sadeghi L, Zoroufchi BH. Acute renal failure during the pregnancy: a review on pathophysiology, risk factors and management. Journal of Renal Injury Prevention 2018; 7(4):314-20.
  24. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The lancet 2016; 387(10017):462-74.