Analysis of clinical characteristics and pregnancy outcomes of pregnancy-related acute kidney injury among high-risk pregnancy populations

doi:10.3969/j.issn.1674-8115.2026.01.007

Journal of Shanghai Jiao Tong University (Medical Science) ›› 2026, Vol. 46 ›› Issue (1): 60-65.doi: 10.3969/j.issn.1674-8115.2026.01.007

• Clinical research • Previous Articles Next Articles

Analysis of clinical characteristics and pregnancy outcomes of pregnancy-related acute kidney injury among high-risk pregnancy populations

Ying Yiwen¹, Li Shu¹, Zhang Zhen¹, Yu Jingran¹, Zhang Ning²(), Mou Shan¹()

^1.Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^2.Department of Gynecology and Obstetrics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Received:2025-07-14 Accepted:2025-12-05 Online:2026-01-28 Published:2026-01-30
Contact: Zhang Ning, Mou Shan E-mail:ningning1723@126.com;shan_mou@126.com
About author:First author contact:Ying Yiwen contributed to data organization and analysis. Li Shu contributed to data collection, statistical analysis, and manuscript drafting. Zhang Zhen contributed to data organization. Yu Jingran contributed to data analysis. Zhang Ning contributed to study design and manuscript drafting. Mou Shan was responsible for study supervision, data acquisition, and manuscript revision. All authors have read the last version of paper and consented to submission.
Supported by:
Standardized Construction Project of 2025 Traditional Chinese Medicine(2025BZ019);Major Project of 2023 Shanghai Jiao Tong University “Jiaoda Star” (STAR) Program(20230101);“Rising Star in Medicine” Young Medical Talent Training and Support Program [SHWSRS (2024)_70]

Abstract

Abstract:

Objective ·To investigate the incidence and clinical features of pregnancy-related acute kidney injury (Pr-AKI) in high-risk populations and its correlation with adverse pregnancy outcomes. Methods ·This retrospective single-center cohort study included 17 468 singleton pregnancies delivered at Renji Hospital, Shanghai Jiao Tong University School of Medicine between January 2018 and December 2023. General demographic characteristics, comorbidities, pregnancy complications, serum creatinine levels, and pregnancy outcomes were collected. Pr-AKI was diagnosed according to Kidney Disease: Improving Global Outcomes criteria. Adverse pregnancy outcomes, including stillbirth, early preterm birth (gestational age < 34 weeks at delivery), and low birth weight (birth weight<2 500 g), were defined as the primary observation endpoints. Univariate and multivariate Logistic regression analyses were used to assess the impact of Pr-AKI on adverse pregnancy outcomes. Results ·The incidence of Pr-AKI was 0.3% (61/17 468). Compared with the non-AKI group, patients in the AKI group had higher rates of chronic hypertension, chronic kidney disease, and autoimmune diseases (P<0.05). Additionally, the risks of stillbirth, early preterm birth, low birth weight, and preeclampsia of the patients in the AKI group were increased (P<0.001). Multivariate Logistic regression analysis confirmed Pr-AKI as an independent risk factor for adverse pregnancy outcomes (adjusted OR=5.868, 95% CI 3.142—10.957, P<0.001). Conclusion ·Pr-AKI significantly contributes to adverse pregnancy outcomes in high-risk pregnant populations, underscoring the need for early monitoring and intervention.

Key words: pregnancy-related acute kidney injury (Pr-AKI), adverse pregnancy outcome, cohort study, preterm birth, low birth weight

CLC Number:

R544.1

Ying Yiwen, Li Shu, Zhang Zhen, Yu Jingran, Zhang Ning, Mou Shan. Analysis of clinical characteristics and pregnancy outcomes of pregnancy-related acute kidney injury among high-risk pregnancy populations[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(1): 60-65.

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References 13

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Characteristic	AKI group (n=61)	Non-AKI group (n=17 407)	P value
Demographic characteristics
Age/year	32.7±4.2	31.8±4.3	0.096
Gravidity/n	1 (0, 2)	1 (0, 2)	0.699
BMI/(kg·m^-2)	26.2±4.2	26.6±4.9	0.468
MAP/mmHg	99.8±13.0	91.3±9.8	<0.001
Age at menarche/year	13.9±1.2	13.5±1.0	0.026
History of preterm birth/n(%)	2 (3.3)	386 (2.2)	0.655
History of miscarriage/n(%)	31 (50.8)	7 028 (40.4)	0.234
Comorbidities/n(%)
PGDM	2 (3.3)	446 (2.6)	0.671
Chronic hypertension	7 (11.5)	846 (4.9)	0.036
Autoimmune disease	12 (19.7)	1 688 (9.7)	0.016
CKD	19 (31.1)	621 (3.6)	<0.001
Cardiac dysfunction	6 (9.8)	416 (2.4)	<0.001
Obesity	7 (11.5)	1 532 (8.8)	0.610
Pregnancy complications/n(%)
GDM	15 (24.6)	3 512 (20.2)	0.485
Gestational hypertension	8 (13.1)	548 (3.1)	<0.001

Characteristic	AKI group (n=61)	Non-AKI group (n=17 407)	P value
Demographic characteristics
Age/year	32.7±4.2	31.8±4.3	0.096
Gravidity/n	1 (0, 2)	1 (0, 2)	0.699
BMI/(kg·m^-2)	26.2±4.2	26.6±4.9	0.468
MAP/mmHg	99.8±13.0	91.3±9.8	<0.001
Age at menarche/year	13.9±1.2	13.5±1.0	0.026
History of preterm birth/n(%)	2 (3.3)	386 (2.2)	0.655
History of miscarriage/n(%)	31 (50.8)	7 028 (40.4)	0.234
Comorbidities/n(%)
PGDM	2 (3.3)	446 (2.6)	0.671
Chronic hypertension	7 (11.5)	846 (4.9)	0.036
Autoimmune disease	12 (19.7)	1 688 (9.7)	0.016
CKD	19 (31.1)	621 (3.6)	<0.001
Cardiac dysfunction	6 (9.8)	416 (2.4)	<0.001
Obesity	7 (11.5)	1 532 (8.8)	0.610
Pregnancy complications/n(%)
GDM	15 (24.6)	3 512 (20.2)	0.485
Gestational hypertension	8 (13.1)	548 (3.1)	<0.001

Pregnancy outcome	AKI group (n=61)	Non-AKI group (n=17 407)	P value	Univariate Logistic regression analysis
Pregnancy outcome	AKI group (n=61)	Non-AKI group (n=17 407)	P value	OR (95% CI)	P value
Primary outcomes/n(%)
Stillbirth	4 (6.6)	210 (1.2)	<0.001	5.747 (2.066‒15.983)	<0.001
Late preterm birth	22 (38.6)	2 008 (11.7)	<0.001	4.755 (2.784‒8.121)	<0.001
Early preterm birth	11 (19.3)	531 (3.1)	<0.001	7.654 (3.942‒14.862)	<0.001
Low birth weight	20 (35.1)	1 225 (7.1)	<0.001	7.048 (4.078‒12.180)	<0.001
Very low birth weight	9 (15.8)	214 (1.2)	<0.001	14.880 (7.210‒30.711)	<0.001
Secondary outcomes/n(%)
Preeclampsia	19 (31.1)	802 (4.6)	<0.001	9.366 (5.423‒16.178)	<0.001
Cesarean section	47 (82.5)	10 692 (62.2)	0.002	2.859 (1.444‒5.663)	0.001

Pregnancy outcome	AKI group (n=61)	Non-AKI group (n=17 407)	P value	Univariate Logistic regression analysis
Pregnancy outcome	AKI group (n=61)	Non-AKI group (n=17 407)	P value	OR (95% CI)	P value
Primary outcomes/n(%)
Stillbirth	4 (6.6)	210 (1.2)	<0.001	5.747 (2.066‒15.983)	<0.001
Late preterm birth	22 (38.6)	2 008 (11.7)	<0.001	4.755 (2.784‒8.121)	<0.001
Early preterm birth	11 (19.3)	531 (3.1)	<0.001	7.654 (3.942‒14.862)	<0.001
Low birth weight	20 (35.1)	1 225 (7.1)	<0.001	7.048 (4.078‒12.180)	<0.001
Very low birth weight	9 (15.8)	214 (1.2)	<0.001	14.880 (7.210‒30.711)	<0.001
Secondary outcomes/n(%)
Preeclampsia	19 (31.1)	802 (4.6)	<0.001	9.366 (5.423‒16.178)	<0.001
Cesarean section	47 (82.5)	10 692 (62.2)	0.002	2.859 (1.444‒5.663)	0.001

Characteristic	OR (95% CI)	P value
Age	1.021 (1.005‒1.030)	0.005
Gravidity	1.201 (1.155‒1.246)	<0.001
BMI	0.944 (0.926‒0.957)	<0.001
MAP	1.044 (1.034‒1.044)	<0.001
Age at menarche	1.050 (0.985‒1.110)	0.140
History of preterm birth	3.068 (2.397‒3.935)	<0.001
History of miscarriage	1.446 (1.295‒1.615)	<0.001
PDGM	1.400 (1.038‒1.889)	0.030
Chronic hypertension	2.957 (2.486‒3.535)	<0.001
Autoimmune disease	2.503 (2.174‒2.865)	<0.001
CKD	2.106 (1.702‒2.623)	<0.001
Cardiac dysfunction	2.002 (1.522‒2.639)	<0.001
Obesity	0.886 (0.740‒1.081)	0.250
GDM	1.093 (0.958‒1.238)	0.190
Gestational hypertension	1.251 (0.957‒1.638)	0.100
AKI	8.610 (4.986‒14.877)	<0.001

Analysis of clinical characteristics and pregnancy outcomes of pregnancy-related acute kidney injury among high-risk pregnancy populations

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