Injuria renal aguda en la gestación: experiencia en un hospital general en Arequipa-Perú, 2003-2013 / Acute kidney injury during pregnancy: experience in a general hospital in Arequipa - Peru: 2003 - 2013

RESUMEN

Antecedente: La injuria renal aguda (IRA) durante la gestación es una complicación con riesgo de mortalidad materna. Objetivo: Determinar las características clínicas y laboratoriales de gestantes con IRA. Material y métodos: Estudio descriptivo, realizado en el Hospital Regional Honorio Delgado en Arequipa con todas las gestantes con diagnóstico de IRA atendidas en el periodo 2003-2013. Resultados: Se evaluó 65 pacientes, se encontró una frecuencia de 6,5 casos/año, 20% ocurrió en las primeras 20 semanas, 13,9% por aborto y 80% después de las 20 semanas, 52,3% por preeclampsia/Hellp. La edad promedio fue de 27,9±7,4 años, se encontró mayor frecuencia de sepsis en las primeras 20 semanas (77 vs 19%, p<0,0001) y menores niveles de potasio (3,2±0,96 vs 3,96±1,15 meq/l, p=0,03). Después de las 20 semanas presentaron menos plaquetas (163 545 ± 107 547 vs 98 978 ± 82 784 mm3, p=0,02) y mayor nivel de TGP (20±21 vs 155±27 U/l, p<0,0001). El 13,8% fallecieron y tuvieron mayor nivel de creatinina (2,63±2,3 vs 4,75±5,16, p=0,04), pCO2 (27±17 vs 50±28, p=0,001), DHL (2099±1903 vs 4153±1525, p=0,02) y menor nivel de pH (7,29±0,17 vs 7,09±0,2, p:0,002). Se encontró una mayor frecuencia de mortalidad hasta las 20 semanas (30,7 vs 9,6%; OR: 4,17; IC95%: 0,93-18,64, p=0,07). Conclusiones: La IRA en la gestación es causada principalmente por aborto y preeclampsia/Hellp hasta y después de las 20 semanas de gestación respectivamente, una de cada siete gestantes con IRA fallece

ABSTRACT

Background: Acute kidney injury (AKI) during pregnancy is a complication leading to maternal mortality risk. Objectives: To determine the clinical and laboratory characteristics of pregnant women with AKI (P-AKI). Methods: A descriptive study was carried out in Honorio Delgado Regional Hospital in Arequipa, Peru. All pregnant women diagnosed with AKI during the 2003 - 2013 period were included. Results: Sixty five patients were assessed, and the annual frequency of P-AKI was 6.5 cases/year. Twenty percent of P-AKI cases occurred in the first 20 weeks, 13.9% after miscarriage and 80% after 20 weeks; 52.3% occurred because of preeclampsia/Hellp syndrome. The average age of affected patients was 27.9 ± 7.4 years, sepsis was more frequent in the first 20 weeks of pregnancy (77 vs. 19%, p<0.0001), as well as lower potassium levels (3.2 ± 0.96 vs. 3.96 ± 1.15 mEq/L, p<0.03). After 20 weeks, patients with P-AKI had lower platelet counts (163,545 ± 107,547 vs. 98,978 ± 82,784 mm3, p<0.02) and higher ALT levels (20 ± 21 vs. 155 ± 27 U/L, p<0.0001). Nearly 14% of patients died (13.8%) and they also had higher creatinine (2.63 ± 2.3 vs. 4.75 ± 5.16, p= 0.04), pCO2 (27 ± 17 vs. 50 ± 28, p=0.001), and LDH levels (2099 ± 1903 vs. 4153 ± 1525, p= 0.02) and lower pH values (7.29 ± 0.17 vs. 7.09 ± 0.2, p= 0.002). The mortality rate was higher up to 20 weeks of pregnancy (30.7 vs. 9.6%; OR: 4.17; 95% CI: 0.93-18.64, p= 0.07). Conclusions: AKI during pregnancy is mainly caused by miscarriage and preeclampsia/HELLP syndrome before and after 20 weeks of pregnancy, respectively; and one out of seven pregnant women affected dies because of this condition