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Acute kidney injury in pregnancy and the role of underlying CKD: a point of view from México

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Abstract

The incidence of acute kidney injury in pregnancy (P-AKI) in developed countries is significantly lower than in develo** ones, where it is estimated to range between 4 and 26%. Mortality in cases of P-AKI requiring dialysis is high, varying from 20 to 80%. In develo** countries, clinical decisions are often based on the availability of services and not on needs. Prenatal surveillance in Mexico does not include serum creatinine, limiting the potential for early diagnosis of AKI and CKD and their differential diagnosis. There are few specialized centers for the care of a pregnancy complicated with kidney disease in Mexico. P-AKI superimposed on preexistent, and usually undiagnosed CKD, is common: in Guadalajara 10 out of the 27 patients with Stage 3–5 CKD or nephrotic proteinuria, that were followed in 2013–2015, required renal replacement therapy (RRT) in pregnancy; in the same period in Mexico City out of 18 patients with P-AKI requiring dialysis, 5 remained dialysis dependent, 3 started dialysis in the following year after their pregnancy and only 1 fully recovered renal function. The grim prognosis is exacerbated by the fact that 70% of Mexicans are not reimbursed for dialysis, and pregnancy-related coverage lasts for only 42 days after delivery. Perinatal results are no less troubling, as most patients with P-AKI give birth preterm to small or very small babies. While our data do not allow us to evaluate needs, they do make it possible to define the complexity of the problems faced in the care of P-AKI in Mexico. Early diagnosis of P-AKI and chronic kidney disease (CKD) is needed to protect mothers and children and the country urgently needs programs to enable it to fulfil the World Health Organization’s imperative that we “make every mother and child count”.

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Acknowledgements

The first two Authors and the last three Authors equally contributed to the paper.

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Authors and Affiliations

  1. Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Jal, Mexico

    Margarita Ibarra-Hernández, María Luz de la Alcantar-Vallín, María Patricia Jiménez-Alvarado, Kenia Benitez Castro, Francisco Villa-Villagrana, Mario Borbolla & Guillermo García-García

  2. Instituto Nacional de Perinatología, México City, Mexico

    Oralia Alejandra Orozco-Guillén, Juan Manuel Gallardo-Gaona & Norberto Reyes-Paredes

  3. Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico

    Ruben Garrido-Roldan

  4. CH Le Mans, Le Mans France, University of Torino, Turin, Italy

    Giorgina Barbara Piccoli

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  1. Margarita Ibarra-Hernández
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  2. Oralia Alejandra Orozco-Guillén
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  3. María Luz de la Alcantar-Vallín
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  12. Giorgina Barbara Piccoli
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Correspondence to Margarita Ibarra-Hernández.

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This article is part of the topical collection on Obstetric Nephrology.

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Ibarra-Hernández, M., Orozco-Guillén, O.A., de la Alcantar-Vallín, M.L. et al. Acute kidney injury in pregnancy and the role of underlying CKD: a point of view from México. J Nephrol 30, 773–780 (2017). https://doi.org/10.1007/s40620-017-0444-4

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