High altitude-related hypertensive crisis and acute kidney injury in an asymptomatic healthy individual

Abstract Background Pregnancy-related acute kidney injury (Pr-AKI) is associated with maternal and fetal morbidity and mortality. There are few studies focusing on Pr-AKI at high altitude in the literature. Objectives to investigate the incidence, etiology, clinical features and maternal-fetal outcomes of Pr-AKI in women living at high altitude. Methods 6,512 pregnant women attending the Department of Obstetrics & Gynecology at local hospital from January 2015 to December 2018 were screened for Pr-AKI. Patients with serum creatinine above normal range(> 70umol/L) then underwent assessment to confirm the diagnosis of Pr-AKI. AKI was diagnosed and staged based on Kidney Disease Improving Global Outcomes(KDIGO) guideline. Individuals meeting the Pr-AKI criteria were recruited. Their clinical data were recorded and retrospectively analyzed. Results Pr-AKI was identified in 136/6512(2.09 %) patients. Hypertensive disorders of pregnancy(HDP) was the leading cause of Pr-AKI(35.3 %). 4(2.9 %) women died and the majority(86.1 %) had recovered renal function before discharge. Fetal outcomes were confirmed in 109 deliveries with gestational age ≥ 20 weeks. Pre-term delivery occurred in 30(27.3 %) cases and perinatal deaths in 17(15.5 %). The rate of low birth weight infant(LBWI) and intrauterine growth restriction(IUGR) was 22.0 and 10.9 % respectively. 16(14.5 %) infants were admitted to NICU after birth. Patients with HDP had a higher cesarean rate(56.3 %). More IUGR(25.0 %) and LBWI(37.8 %) were observed in their infants with a higher risk of admission to NICU(22.0 %). High altitude might have an adverse impact on HDP-related Pr-AKI patients with earlier terminated pregnancy and more stillbirth/neonatal death. Logistic regression models indicated that uncontrolled blood pressure, high altitude and advanced AKI were associated with adverse fetal outcomes in HDP-related Pr-AKI patients. Conclusions Pr-AKI was not rare in high-altitude regions and caused severe fetal morbidities and mortalities. Uncontrolled blood pressure, high altitude and advanced AKI were all risk factors for adverse fetal outcomes in Pr-AKI patients, especially for those with hypertensive disorders of pregnancy.

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Pregnancy-Related Acute Kidney Injury at High Altitude: A Retrospective Observational Study in a Single Center

10.21203/rs.3.rs-99651/v1 ◽

2020 ◽

Author(s):

Weiming Wang ◽

Xin Li ◽

Xiaojing Wu ◽

Muyin Zhang ◽

Lili Xu ◽

...

Keyword(s):

Blood Pressure ◽

Acute Kidney Injury ◽

High Altitude ◽

Kidney Injury ◽

Hypertensive Disorders Of Pregnancy ◽

Fetal Outcomes ◽

Uncontrolled Blood Pressure ◽

Logistic Regression Models ◽

Hypertensive Disorders ◽

Term Delivery

Abstract BackgroundPregnancy-related acute kidney injury (Pr-AKI) is associated with maternal and fetal morbidity and mortality. There are few studies focusing on Pr-AKI at high altitude in the literature. Objectivesto investigate the incidence, etiology, clinical features and maternal-fetal outcomes of Pr-AKI in women living at high altitude.Methods6,512 pregnant women attending the Department of Obstetrics＆Gynecology at local hospital from January 2015 to December 2018 were screened for Pr-AKI. Patients with serum creatinine above normal range(>70umol/L) then underwent assessment to confirm the diagnosis of Pr-AKI. AKI was diagnosed and staged based on Kidney Disease Improving Global Outcomes(KDIGO) guideline. Individuals meeting the Pr-AKI criteria were recruited. Their clinical data were recorded and retrospectively analyzed. ResultsPr-AKI was identified in 136/6512(2.09%) patients. Hypertensive disorders of pregnancy(HDP) was the leading cause of Pr-AKI(35.3%). 4(2.9%) women died and the majority(86.1%) had recovered renal function before discharge. Fetal outcomes were confirmed in 109 deliveries with gestational age≥20 weeks. Pre-term delivery occurred in 30(27.3%) cases and perinatal deaths in 17(15.5%). The rate of low birth weight infant(LBWI) and intrauterine growth restriction(IUGR) was 22.0% and 10.9% respectively. 16(14.5%) infants were admitted to NICU after birth. Patients with HDP had a higher cesarean rate(56.3%). More IUGR(25.0%) and LBWI(37.8%) were observed in their infants with a higher risk of admission to NICU(22.0%). High altitude might have an adverse impact on HDP-related Pr-AKI patients with earlier terminated pregnancy and more stillbirth/neonatal death. Logistic regression models indicated that uncontrolled blood pressure, high altitude and advanced AKI were associated with adverse fetal outcomes in HDP-related Pr-AKI patients.ConclusionsPr-AKI was not rare in high-altitude regions and caused severe fetal morbidities and mortalities. Uncontrolled blood pressure, high altitude and advanced AKI were all risk factors for adverse fetal outcomes in Pr-AKI patients, especially for those with hypertensive disorders of pregnancy.

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105 Hypertensive Crisis and Acute Kidney Injury (AKI) Due to Spontaneous Cholesterol Emboli Syndrome (CES) in Nonagenarian

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2018.02.111 ◽

2018 ◽

Vol 71 (4) ◽

pp. 541

Keyword(s):

Acute Kidney Injury ◽

Hypertensive Crisis ◽

Kidney Injury

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Does long-term high-altitude exposure reduce myocardial injury and incidence of acute kidney injury following cardiac surgery? A propensity score matched study

10.21203/rs.3.rs-1052952/v1 ◽

2021 ◽

Author(s):

Mengxue Liu ◽

Man Wang ◽

Jia Huang ◽

Zuojia Zeng ◽

Keli Huang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Propensity Score ◽

High Altitude ◽

Lower Incidence ◽

Myocardial Injury ◽

Ischemia Reperfusion ◽

Kidney Injury ◽

Altitude Exposure

Abstract Objective Chronic high-altitude exposure has been shown to reduce ischemia-reperfusion injury in animal experiments. The objective was to evaluate the clinical protective effect of long-term high-altitude hypoxic exposure for patients undergoing cardiac surgery with cardiopulmonary bypass. Methods In this retrospective cohort study, data from patients who underwent cardiac procedures between January 2013 and December 2019 at a single center was collected. Patients were divided into highlander group (> 2500 m) and lowlander group (< 1500 m) according to the altitude of their residence. A propensity-score-matched analysis was performed to estimate the association of long-term high-altitude exposure and cardiac surgery outcomes. Results In a total of 2085 patients, 128 highlander patients were matched to 248 lowlander patients. The levels of CK-MB and hs-TnI upon arrival at the intensive care unit were lower in the highlander group compared to the lowlander group [70.6 U/L (56.0, 92.6) vs 85.0 U/L (68.5, 113.5), P < 0.001; 6.1 ng/mL (3.3,11.2) vs 7.9 ng/mL (3.6, 14.1), P = 0.011, respectively]. The highlander group also had a lower incidence of acute kidney injury (13.3% vs 21.8%, P = 0.046). The in-hospital mortality in the highlander group was lower than in the lowlander group without statistical significance (0.8% vs 4.0%, P = 0.107). Conclusions Long-term high-altitude exposure was associated with less myocardial injury and a lower incidence of acute kidney injury after cardiac surgery.

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