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Clinical Epidemiology
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Pregnancy Outcomes after Clinical Recovery from AKI

Jessica Sheehan Tangren, Camille E. Powe, Elizabeth Ankers, Jeffrey Ecker, Kate Bramham, Michelle A. Hladunewich, S. Ananth Karumanchi and Ravi Thadhani
JASN May 2017, 28 (5) 1566-1574; DOI: https://doi.org/10.1681/ASN.2016070806
Jessica Sheehan Tangren
*Division of Nephrology, Department of Medicine,
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Camille E. Powe
†Division of Endocrinology, Department of Medicine, and
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Elizabeth Ankers
*Division of Nephrology, Department of Medicine,
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Jeffrey Ecker
‡Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts;
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Kate Bramham
§Department of Renal Medicine, King’s College London and King’s Health Partners, London, United Kingdom;
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Michelle A. Hladunewich
‖Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; and
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S. Ananth Karumanchi
¶Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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Ravi Thadhani
*Division of Nephrology, Department of Medicine,
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Abstract

The effect of clinically recovered AKI (r-AKI) on future pregnancy outcomes is unknown. We retrospectively studied all women who delivered infants between 1998 and 2007 at Massachusetts General Hospital to assess whether a previous episode of r-AKI associated with subsequent adverse maternal and fetal outcomes, including preeclampsia. AKI was defined as rise in serum creatinine concentration to 1.5-fold above baseline. We compared pregnancy outcomes in women with r-AKI without history of CKD (eGFR>90 ml/min per 1.73 m2 before conception; n=105) with outcomes in women without kidney disease (controls; n=24,640). The r-AKI and control groups had similar prepregnancy serum creatinine measurements (0.70±0.20 versus 0.69±0.10 mg/dl; P=0.36). However, women with r-AKI had increased rates of preeclampsia compared with controls (23% versus 4%; P<0.001). Infants of women with r-AKI were born earlier than infants of controls (37.6±3.6 versus 39.2±2.2 weeks; P<0.001), with increased rates of small for gestational age births (15% versus 8%; P=0.03). After multivariate adjustment, r-AKI associated with increased risk for preeclampsia (adjusted odds ratio [aOR], 5.9; 95% confidence interval [95% CI], 3.6 to 9.7) and adverse fetal outcomes (aOR, 2.4; 95% CI, 1.6 to 3.7). When women with r-AKI and controls were matched 1:2 by age, race, body mass index, diastolic BP, parity, and diabetes status, r-AKI remained associated with preeclampsia (OR, 4.7; 95% CI, 2.1 to 10.1) and adverse fetal outcomes (OR, 2.1; 95% CI, 1.2 to 3.7). Thus, a past episode of AKI, despite return to normal renal function before pregnancy, associated with adverse outcomes in pregnancy.

  • acute renal failure
  • pregnancy
  • preeclampsia
  • clinical epidemiology
  • Copyright © 2017 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 28 (5)
Journal of the American Society of Nephrology
Vol. 28, Issue 5
May 2017
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Pregnancy Outcomes after Clinical Recovery from AKI
Jessica Sheehan Tangren, Camille E. Powe, Elizabeth Ankers, Jeffrey Ecker, Kate Bramham, Michelle A. Hladunewich, S. Ananth Karumanchi, Ravi Thadhani
JASN May 2017, 28 (5) 1566-1574; DOI: 10.1681/ASN.2016070806

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Pregnancy Outcomes after Clinical Recovery from AKI
Jessica Sheehan Tangren, Camille E. Powe, Elizabeth Ankers, Jeffrey Ecker, Kate Bramham, Michelle A. Hladunewich, S. Ananth Karumanchi, Ravi Thadhani
JASN May 2017, 28 (5) 1566-1574; DOI: 10.1681/ASN.2016070806
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Cited By...

  • Animal Model of Pregnancy after Acute Kidney Injury Mirrors the Human Observations
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  • Updates in Diagnosis and Management of Preeclampsia in Women with CKD
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  • Metabolic and Hypertensive Complications of Pregnancy in Women with Nephrolithiasis
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