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VOLUME 25 , ISSUE 9 ( September, 2021 ) > List of Articles

Original Article

Acute Kidney Injury in Severe Preeclamptic Patients Admitted to Intensive Care Unit: Epidemiology and Role of Serum Neutrophil Gelatinase-associated Lipocalcin

Asha Tyagi, Pooja Yadav, Rashmi Salhotra, Shukla Das, Praveen K Singh, Devansh Garg

Keywords : Acute kidney injury, Intensive care unit, Neutrophil gelatinase-associated lipocalcin, Preeclampsia, Pregnancy

Citation Information : Tyagi A, Yadav P, Salhotra R, Das S, Singh PK, Garg D. Acute Kidney Injury in Severe Preeclamptic Patients Admitted to Intensive Care Unit: Epidemiology and Role of Serum Neutrophil Gelatinase-associated Lipocalcin. Indian J Crit Care Med 2021; 25 (9):1013-1019.

DOI: 10.5005/jp-journals-10071-23966

License: CC BY-NC 4.0

Published Online: 08-09-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Patients with preeclampsia admitted to the intensive care unit (ICU) may have risk factors for acute kidney injury (AKI). Although the use of neutrophil gelatinase-associated lipocalcin (NGAL) to predict AKI is previously validated, we could locate only scanty data regarding the epidemiology of AKI and role of NGAL in preeclamptic patients admitted to ICU. Methods: Patients with preeclampsia admitted to our ICU were included. The incidence and severity of AKI during the entire ICU stay were assessed using kidney disease improving global outcomes criteria, while the a priori risk factors and serum NGAL were also evaluated. Results: A total of 52 preeclamptic patients admitted to ICU were included, among whom the majority had eclampsia (75%). AKI developed in 25 (48.1%) patients with stages 1, 2, and 3 in 56, 36, and 8%, respectively. The incidence of sepsis (16 vs 0%), shock (40 vs 7.4%), and anemia (84 vs 59.3%) was significantly greater in patients with AKI (p < 0.05). ICU mortality (28 vs 3.7%), duration of ICU, and hospital stay were significantly higher in patients who developed AKI (p < 0.05). There was no association of serum NGAL [274 (240–335) ng/mL] with AKI or the mortality (p = 0.725, 0.861); there was, however, a significant discriminatory value for eclampsia [p = 0.019; area under curve = 0.736 (95% confidence interval: 0.569–0.904)]. Conclusions: Although AKI is common among patients with preeclampsia admitted to ICU, serum NGAL does not predict its occurrence.


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  1. Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011;25(4):391–403. DOI: 10.1016/j.bpobgyn.2011.01.006.
  2. Hypertensive disorders in pregnancy. In: Dutta DC, Konar H, editors. Textbook of obstetrics. 8th ed. New Delhi: Jaypee; 2015. p. 256–267.
  3. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 202: gestational hypertension and preeclampsia. Obstet Gynecol 2019;133(1):e1–e25. DOI: 10.1097/AOG.0000000000003018.
  4. Bateman BT, Polley LS. Hypertensive disorders. In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y, Mhyre JM, editors. Chestnut's obstetric anaesthesia. 5th ed. Philadelphia: Elsevier; 2014. p. 826–850.
  5. Codsi E, Garovic VD, Gonzalez-Suarez ML, Milic N, Borowski KS, Rose CH, et al. Longitudinal characterization of renal proximal tubular markers in normotensive and preeclamptic pregnancies. Am J Physiol Regul Integr Comp Physiol 2017;312(5):R773–R778.
  6. Simonazzi G, Capelli I, Curti A, Comai G, Rizzo N, La Manna G. Serum and urinary neutrophil gelatinase-associated lipocalin monitoring in normal pregnancy versus pregnancies complicated by pre-eclampsia. In Vivo 2015;29(1):117–121.
  7. Moran P, Baylis PH, Lindheimer MD, Davison JM. Glomerular ultrafiltration in normal and preeclamptic pregnancy. J Am Soc Nephrol 2003;14(3):648–652. DOI: 10.1097/01.asn.0000051724.66235.e0.
  8. Kidney disease: improving global outcome. Available at: https://www.kdigo.org [Accessed on August 15, 2020].
  9. Tyagi A, Luthra A, Kumar M, Das S. Epidemiology of acute kidney injury and the role of urinary [TIMP-2]·[IGFBP7]: a prospective cohort study in critically ill obstetric patients. Int J Obstet Anesth 2018;36:77–84. DOI: 10.1016/j.ijoa.2018.08.002.
  10. Patel M, Sachan R, Gangwar R, Sachan P, Natu S. Correlation of serum neutrophil gelatinase-associated lipocalin with acute kidney injury in hypertensive disorders of pregnancy. Int J Nephrol Renovasc Dis 2013;6:181–186. DOI: 10.2147/IJNRD.S45523.
  11. Conti-Ramsden FI, Nathan HL, De Greeff A, Hall DR, Seed PT, Chappell LC, et al. Pregnancy-related acute kidney injury in preeclampsia: risk factors and renal outcomes. Hypertension 2019;74(5):1144–1151. DOI: 10.1161/HYPERTENSIONAHA.119.13089.
  12. Samejima T, Yamashita T, Takeda Y, Adachi T. Low antithrombin levels accompanied by high urine protein/creatinine ratios are predictive of acute kidney injury among CS patients with preeclampsia. J Matern Fetal Neonatal Med 2021;34(10):1550–1556. DOI: 10.1080/14767058.2019.1639662.
  13. Tangren JS, Wan Md Adnan WAH, Powe CE, Ecker J, Bramham K, Hladunewich MA, et al. Risk of preeclampsia and pregnancy complications in women with a history of acute kidney injury. Hypertension 2018;72(2):451–459. DOI: 10.1161/HYPERTENSIONAHA.118.11161.
  14. Kamal EM, Behery MM, Sayed GA, Abdulatif HK. RIFLE classification and mortality in obstetric patients admitted to the intensive care unit with acute kidney injury: a 3-year prospective study. Reprod Sci 2014;21(10):1281–1287. DOI: 10.1177/1933719114525277.
  15. 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. J Nephrol 2012;25(5):764–775. DOI: 10.5301/jn.5000058.
  16. Moyake N, Buchmann E, Crowther NJ. Neutrophil gelatinase-associated lipocalin as a diagnostic marker of acute kidney injury in pre-eclampsia. J Obstet Gynaecol Res 2016;42(11):1483–1488. DOI: 10.1111/jog.13088.
  17. D'Anna R, Baviera G, Giordano D, Todarello G, Russo S, Recupero S, et al. Neutrophil gelatinase-associated lipocalin serum evaluation through normal pregnancy and in pregnancies complicated by preeclampsia. Acta Obstet Gynecol Scand 2010;89(2):275–278. DOI: 10.3109/00016340903443676.
  18. Kim SM, Park JS, Norwitz ER, Jung HJ, Kim BJ, Park CW, et al. Circulating levels of neutrophil gelatinase-associated lipocalin (NGAL) correlate with the presence and severity of preeclampsia. Reprod Sci 2013;20(9):1083–1089. DOI: 10.1177/1933719113477480.
  19. Artunc-Ulkumen B, Guvenc Y, Goker A, Gozukara C. Relationship of neutrophil gelatinase-associated lipocalin (NGAL) and procalcitonin levels with the presence and severity of the preeclampsia. J Matern Fetal Neonatal Med 2015;28(16):1895–1900. DOI: 10.3109/14767058.2014.972926.
  20. Sachan R, Patel ML, Gaurav A, Gangwar R, Sachan P. Correlation of serum neutrophil gelatinase associated lipocalin with disease severity in hypertensive disorders of pregnancy. Adv Biomed Res 2014;3:223. DOI: 10.4103/2277-9175.145690.
  21. Yuksel S, Ozyurek SE, Acar DK, Ozdemir C, Guler S, Kiyak H, et al. Urinary neutrophil gelatinase-associated lipocalin is associated with preeclampsia in a cohort of Turkish women. Hypertens Pregnancy 2019;38(3):157–162. DOI: 10.1080/10641955.2019.1621887.
  22. Cui L, Shu C, Liu Z, Tong W, Cui M, Wei C, et al. Serum protein marker panel for predicting preeclampsia. Pregnancy Hypertens 2018;14:279–285. DOI: 10.1016/j.preghy.2018.01.009.
  23. Scazzochio E, Munmany M, Garcia L, Meler E, Crispi F, Gratacos E, et al. Prognostic role of maternal neutrophil gelatinase-associated lipocalin in women with severe early-onset preeclampsia. Fetal Diagn Ther 2014;35:127–132. DOI: 10.1159/000356499.
  24. Huppertz B. Placental origins of preeclampsia: challenging the current hypothesis. Hypertension 2008;51(4):970–975. DOI: 10.1161/HYPERTENSIONAHA.107.107607.
  25. D'Anna R, Baviera G, Giordano D, Todarello G, Corrado F, Buemi M. Second trimester neutrophil gelatinase associated lipocalin as a potential prediagnostic marker of preeclampsia. Acta Obstet Gynecol Scand 2008;87(12):1370–1373. DOI: 10.1080/00016340802464463.
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