{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:06:41Z","timestamp":1792786001804,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Department of Obstetrics and Gynecology, Mayo Clinic, Rochester","id":[{"id":"https:\/\/ror.org\/02qp3tb03","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000871","name":"Mayo Clinic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pregnancy-related acute kidney injury (PrAKI) is an uncommon but serious complication associated with adverse maternal and neonatal outcomes, with limited data in high-resource settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 29 586 deliveries at Mayo Clinic hospitals between 2017 and 2022. PrAKI was defined using Kidney Disease Improving Global Outcomes (KDIGO) creatinine criteria. Maternal characteristics, nephrotoxin exposure, clinical interventions, and neonatal outcomes were compared between patients with and without PrAKI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PrAKI occurred in 341 patients (1.15%). Compared with controls, PrAKI was associated with higher rates of chronic hypertension (28.7% vs 5.2%), cesarean delivery (68.5% vs 35.1%), intensive care unit (ICU) admission (59.1% vs 6.2%), and nephrotoxin exposure (58.7% vs 31.6%) (all P &amp;lt; .0001). Dialysis was required in 7.1% of patients with PrAKI, with 1.17% remaining dependent at discharge and 0.88% at 30 and 90 days; no control patients required dialysis. Neonates of mothers with PrAKI had higher rates of prematurity and neonatal ICU (NICU) admission (48.7% vs 9.8%; P &amp;lt; .0001). Maternal mortality was rare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PrAKI is a marker of severe maternal illness and is associated with adverse maternal and neonatal outcomes. Although most patients recover kidney function, a subset develop persistent dysfunction. Early identification, cautious use of nephrotoxic medications, and structured postpartum follow-up are essential.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/joneph\/aajag125","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T11:46:05Z","timestamp":1777031165000},"source":"Crossref","is-referenced-by-count":0,"title":["Acute kidney injury in pregnancy is associated with increased risks for adverse maternal and neonatal outcomes: an integrated health system study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6868-6481","authenticated-orcid":false,"given":"Mehdi","family":"Kashani","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darah","family":"Dilmaghani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Women's Health Institute, Rutgers Robert Wood Johnson Medical School , New Brunswick, NJ ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regan N","family":"Theiler","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mayo Clinic , Rochester, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Clinical Trials and Biostatistics, Department of Quantitative Health Science, Mayo Clinic , Rochester, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deondre","family":"Jordan","sequence":"additional","affiliation":[{"name":"Division of Clinical Trials and Biostatistics, Department of Quantitative Health Science, Mayo Clinic , Rochester, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danette","family":"Bruns","sequence":"additional","affiliation":[{"name":"Anesthesia Clinical Research Unit, Mayo Clinic , Rochester, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farbod","family":"Yousefi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic , Rochester, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesna D","family":"Garovic","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN ,","place":["United States"]},{"name":"Department of Obstetrics and Gynecology, Mayo Clinic , Rochester, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2184-3683","authenticated-orcid":false,"given":"Kianoush B","family":"Kashani","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN ,","place":["United States"]},{"name":"Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Department of Medicine, Mayo Clinic , Rochester, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"2026101603474468800_aajag125-B1","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/S0140-6736(24)02385-7","article-title":"Acute kidney injury","volume":"405","author":"Ostermann","year":"2025","journal-title":"Lancet"},{"key":"2026101603474468800_aajag125-B2","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1161\/HYPERTENSIONAHA.119.13089","article-title":"Pregnancy-related acute kidney injury in preeclampsia: risk factors and renal outcomes","volume":"74","author":"Conti-Ramsden","year":"2019","journal-title":"Hypertension"},{"key":"2026101603474468800_aajag125-B3","doi-asserted-by":"publisher","first-page":"181","DOI":"10.4103\/0971-4065.194391","article-title":"Postpartum acute kidney injury: experience of a tertiary care center","volume":"27","author":"Mir","year":"2017","journal-title":"Indian J Nephrol"},{"key":"2026101603474468800_aajag125-B4","doi-asserted-by":"publisher","first-page":"318","DOI":"10.3390\/jcm7100318","article-title":"Acute kidney injury in pregnancy: the need for higher awareness. A pragmatic review focused on what could be improved in the prevention and care of pregnancy-related AKI, in the year dedicated to women and kidney diseases","volume":"7","author":"Piccoli","year":"2018","journal-title":"J Clin Med"},{"key":"2026101603474468800_aajag125-B5","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1186\/s12882-017-0551-4","article-title":"Acute kidney injury during pregnancy and puerperium: a retrospective study in a single center","volume":"18","author":"Huang","year":"2017","journal-title":"BMC Nephrol"},{"key":"2026101603474468800_aajag125-B6","doi-asserted-by":"publisher","first-page":"832","DOI":"10.3390\/jcm12030832","article-title":"Correlations between maternal and fetal outcomes in pregnant women with kidney failure","volume":"12","author":"Meca","year":"2023","journal-title":"J Clin Med"},{"key":"2026101603474468800_aajag125-B7","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.ejogrb.2021.04.036","article-title":"Factors associated with acute kidney injury during delivery or the postpartum period: a case control study","volume":"261","author":"Coles","year":"2021","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2026101603474468800_aajag125-B8","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1093\/ndt\/gfaa217","article-title":"Acute kidney injury e-alerts in pregnancy: rates, recognition and recovery","volume":"36","author":"Gama","year":"2021","journal-title":"Nephrol Dial Transplant"},{"key":"2026101603474468800_aajag125-B9","doi-asserted-by":"publisher","first-page":"627","DOI":"10.60787\/NMJ-64-5-361","article-title":"Incidence of pregnancy-related acute kidney injury in a low resource setting: a prospective study","volume":"64","author":"Orhewere","year":"2023","journal-title":"Niger Med J"},{"key":"2026101603474468800_aajag125-B10","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1097\/GRF.0000000000000069","article-title":"Acute kidney injury during pregnancy","volume":"57","author":"Van Hook","year":"2014","journal-title":"Clin Obstet Gynecol"},{"key":"2026101603474468800_aajag125-B11","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1186\/s12884-017-1402-9","article-title":"Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis","volume":"17","author":"Liu","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026101603474468800_aajag125-B12","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1159\/000517697","article-title":"Acute kidney injury in obstetric patients","volume":"199","author":"Cavin","year":"2021","journal-title":"Contrib Nephrol"},{"key":"2026101603474468800_aajag125-B13","doi-asserted-by":"publisher","first-page":"11","DOI":"10.5005\/japi-11001-0064","article-title":"Pregnancy-related acute kidney injury in public hospital in South India: changing trends","volume":"70","author":"Sahay","year":"2022","journal-title":"J Assoc Physicians India"},{"key":"2026101603474468800_aajag125-B14","doi-asserted-by":"publisher","first-page":"535","DOI":"10.29271\/jcpsp.2023.05.535","article-title":"Acute kidney injury due to obstetric complications","volume":"33","author":"Mal","year":"2023","journal-title":"J Coll Physicians Surg Pak"},{"key":"2026101603474468800_aajag125-B15","doi-asserted-by":"publisher","first-page":"889","DOI":"10.3109\/0886022X.2016.1164015","article-title":"Postpartum acute kidney injury: a review of 99 cases","volume":"38","author":"Eswarappa","year":"2016","journal-title":"Ren Fail"},{"key":"2026101603474468800_aajag125-B16","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1177\/00494755231157109","article-title":"Acute kidney injury in obstetrics: hospital-based cohort study","volume":"53","author":"Kharkongor","year":"2023","journal-title":"Trop Doct"},{"key":"2026101603474468800_aajag125-B17","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1007\/s40620-021-01133-8","article-title":"Acute kidney injury during pregnancy and puerperium: an Egyptian hospital-based study","volume":"34","author":"Gaber","year":"2021","journal-title":"J Nephrol"},{"key":"2026101603474468800_aajag125-B18","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1016\/j.mayocp.2024.09.004","article-title":"Decreasing fertility rate in the United States: demographics, challenges, and consequences","volume":"99","author":"Dilmaghani","year":"2024","journal-title":"Mayo Clin Proc"},{"key":"2026101603474468800_aajag125-B19","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1097\/AOG.0000000000001374","article-title":"Investigation of a rise in obstetric acute renal failure in the United States, 1999\u20132011","volume":"127","author":"Mehrabadi","year":"2016","journal-title":"Obstet Gynecol"},{"key":"2026101603474468800_aajag125-B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2022.110915","article-title":"Impact of cesarean versus vaginal delivery on the risk of postpartum acute kidney injury: a retrospective database controlled study in 116,876 parturients","volume":"82","author":"Potnuru","year":"2022","journal-title":"J Clin Anesth"},{"key":"2026101603474468800_aajag125-B21","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/j.kint.2025.02.021","article-title":"Women and kidney health: conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference","volume":"108","author":"Piccoli","year":"2025","journal-title":"Kidney Int"},{"key":"2026101603474468800_aajag125-B22","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1038\/s41581-025-00979-6","article-title":"Pregnancy-associated acute kidney injury\u2014consensus report of the 32nd acute disease quality initiative workgroup","volume":"21","author":"Nelson-Piercy","year":"2025","journal-title":"Nat Rev Nephrol"},{"key":"2026101603474468800_aajag125-B23","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1038\/kisup.2011.32","article-title":"Section 2: AKI definition","volume":"2","author":"Anonymous","year":"2012","journal-title":"Kidney Int Suppl (2011)"},{"key":"2026101603474468800_aajag125-B24","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1093\/aje\/kwq433","article-title":"Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries","volume":"173","author":"Quan","year":"2011","journal-title":"Am J Epidemiol"},{"key":"2026101603474468800_aajag125-B25","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1007\/s00404-012-2323-5","article-title":"Kidney injury during pregnancy: associated comorbid conditions and outcomes","volume":"286","author":"Gurrieri","year":"2012","journal-title":"Arch Gynecol Obstet"},{"key":"2026101603474468800_aajag125-B26","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s40748-025-00224-9","article-title":"Pregnancy-associated acute kidney injury as an important driver of chronic kidney disease in females in developing countries: a systematic review","volume":"11","author":"Meena","year":"2025","journal-title":"Matern Health Neonatol Perinatol"},{"key":"2026101603474468800_aajag125-B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.semnephrol.2023.151317","article-title":"Pregnancy-associated acute kidney injury in low-resource settings: progress over the last decade","volume":"42","author":"Davidson","year":"2022","journal-title":"Semin Nephrol"},{"key":"2026101603474468800_aajag125-B28","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1159\/000505894","article-title":"Pregnancy-related acute kidney injury in the United States: clinical outcomes and health care utilization","volume":"51","author":"Shah","year":"2020","journal-title":"Am J Nephrol"},{"key":"2026101603474468800_aajag125-B29","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1186\/s12882-024-03616-9","article-title":"Characteristics and outcome of pregnancy-related acute kidney injury in a teaching hospital in a low-resource setting: a five-year retrospective review","volume":"25","author":"Berhe","year":"2024","journal-title":"BMC Nephrol"},{"key":"2026101603474468800_aajag125-B30","doi-asserted-by":"publisher","first-page":"3085","DOI":"10.1681\/ASN.2014100954","article-title":"Characteristics and outcomes of AKI treated with dialysis during pregnancy and the postpartum period","volume":"26","author":"Hildebrand","year":"2015","journal-title":"J Am Soc Nephrol"}],"container-title":["Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/joneph\/advance-article-pdf\/doi\/10.1093\/joneph\/aajag125\/72020338\/aajag125.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joneph\/advance-article-pdf\/doi\/10.1093\/joneph\/aajag125\/72020338\/aajag125.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:47:49Z","timestamp":1792136869000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joneph\/advance-article\/doi\/10.1093\/joneph\/aajag125\/8928711"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":30,"URL":"https:\/\/doi.org\/10.1093\/joneph\/aajag125","relation":{},"ISSN":["1121-8428","1724-6059"],"issn-type":[{"value":"1121-8428","type":"print"},{"value":"1724-6059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"article-number":"aajag125"}}