Changing epidemiology of acute kidney injury in pregnancy: A journey of four decades from a developing country

Saudi J Kidney Dis Transpl. 2019 Sep-Oct;30(5):1118-1130. doi: 10.4103/1319-2442.270268.


The incidence of acute kidney injury in pregnancy (P-AKI) has markedly decreased over the last three decades in India, particularly due to decreased incidence of postabortion AKI. However, P-AKI still accounts for 3%-5% of cases of total AKI. Postabortion sepsis has decreased to between 0.9% and 1.5% in 2014 from 9.4% in 1980-1990 in the new millennium. Currently, in India, majority of P-AKI (70%-90%) occurs in the postpartum period and in late 3rd trimester similar to the developed countries, but causes are different. We observed that preeclampsia/eclampsia is the most common cause of P-AKI in the late 3rd trimester and postpartum period followed by puerperal sepsis and postpartum hemorrhage (PPH). Both puerperal sepsis and PPH are treatable and preventable etiologies of P-AKI. Timely and aggressive management of antepartum hemorrhage (APH/PPH) and puerperal sepsis are required to reduce the burden of P-AKI in developing countries. Specific-pregnancy disorders such as P-aHUS/thrombotic thrombocytopenic purpura, pregnancy-associated thrombotic microangiopathy, and acute fatty liver of pregnancy are the uncommon/rare causes of P-AKI in India and possibly also because of the lack of awareness toward diagnosis. Despite decreasing incidence of P-AKI, fetal mortality remained high and unchanged. However, maternal mortality has decreased to 5% from initial high mortality of 20%-25%. The incidence and severity of renal cortical necrosis have significantly decreased at our center.

Publication types

  • Review

MeSH terms

  • Abortion, Induced / adverse effects
  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / epidemiology*
  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / therapy
  • Developing Countries*
  • Female
  • Humans
  • Incidence
  • India / epidemiology
  • Maternal Mortality
  • Pregnancy
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications / epidemiology*
  • Pregnancy Complications / mortality
  • Pregnancy Complications / therapy
  • Risk Assessment
  • Risk Factors
  • Time Factors