Fulltext (PDF)
DOI: 10.48087/BJMS.2026.130308
Authors: Ouafa GUELLATI1, Ouissem GUELLATI2,Mehdi MIADI3, Imed DIABI1, Amina BELLILI1
Affiliations: 1- Service de Gynécologie-Obstétrique, CHU Ibn Rochd, Annaba / Université Badji Mokhtar, Annaba – Algérie. 2- Service de cardiologie CHU Ibn Sina Annaba / Université Badji Mokhtar, Annaba – Algérie. 3- Service de néphrologie CHU Ibn Sina Annaba / Université Badji Mokhtar, Annaba – Algérie.
Abstract
Background/Objective: Severe preeclampsia (PE) frequently leads to acute kidney injury (AKI), with serious maternal-fetal consequences. This prospective study aimed to identify independent clinical and biological predictors of AKI in PE and to evaluate its maternal-fetal prognostic impact. Materials and Methods: This prospective analytical study (2020–2023), conducted at Ibn Rochd University Hospital, Annaba, included 1,254 preeclamptic patients from 54,830 deliveries, divided into 310 AKI cases — defined by serum creatinine >90 µmol/L, and/or urea >7 mmol/L, and/or urine output <400 mL/24h, classified using the AKIN staging system — and 944 controls. Sociodemographic, clinical (blood pressure, proteinuria, oliguria), and biological variables (hemoglobin, uricemia) were analyzed using univariate tests (χ², t-test; p<0.05) and stepwise descending multivariate logistic regression (SPSS v25.0). Results: The incidence of PE was 2.28% (1,254/54,830), and the incidence of AKI was 24.7% (310/1,254), predominantly AKIN stage 1 (82.9%). Univariate analysis identified the following risk factors: emergency transfer (RR=2.80, 95% CI [2.23–3.50]), blood pressure >160/110 mmHg (RR=1.78 [1.47–2.17]), massive proteinuria >3.5 g/24h (RR=2.60 [2.17–3.12]), oliguria (RR=3.21 [1.96–3.54]), and iron-deficiency anemia (Hb <10 g/dL; RR=3.05 [2.52–3.68]), all p<0.0001. Multivariate logistic regression confirmed five independent predictors: emergency transfer (aOR=2.45, 95% CI [1.85–3.25]), severe hypertension (aOR=1.62 [1.28–2.05]), massive proteinuria (aOR=2.12 [1.68–2.68]), oliguria (aOR=2.78 [2.05–3.77]), and anemia (aOR=2.41 [1.92–3.03]), all p<0.0001. Maternal morbidity included HELLP syndrome (49.4%, RR=4.5), retroplacental hematoma (23.9%), eclampsia (18.7%), and all 12 maternal deaths occurred in the AKI group (mortality rate: 3.9%). Perinatal outcomes included prematurity <34 weeks (57.4%, RR=3.18), neonatal mortality (35.5%, RR=4.59 [3.58–5.89]), and prolonged hospitalization (8.27±5.99 vs. 5.42±4.38 days). Renal recovery occurred in 78.7% of cases by day 7; 17.4% required hemodialysis (mean 3±2.22 sessions), and 2.2% progressed to chronic kidney disease. Conclusion: AKI frequently complicates severe PE. Multivariate analysis identifies five major independent predictors that enable early high-risk stratification. Proactive multidisciplinary management targeting delayed transfer, severe hypertension, massive proteinuria, oliguria, and anemia is essential to prevent dialysis dependence, chronic kidney disease, and maternal-fetal mortality.
Keywords: severe preeclampsia, acute kidney injury, independent predictive factors, maternal-fetal prognosis.