Clinical Characteristics, Predictors, and Outcomes of Pregnancy-Related Acute Kidney Injury in a Tertiary Hospital in Ghana: A Retrospective Study

Background Pregnancy-related acute kidney injury (PRAKI) remains a major contributor to maternal morbidity and mortality in low- and middle-income countries despite global advances in obstetric and renal care. In Ghana, contemporary data are scarce, limiting the understanding of its clinical spectrum and outcomes. This study evaluated the demographic, clinical, biochemical, and obstetric predictors of maternal outcomes among women with PRAKI managed at the Komfo Anokye Teaching Hospital (KATH), Kumasi. Methods A hospital-based retrospective cross-sectional study was conducted among 108 women diagnosed with PRAKI between 2020 and 2024. Data on sociodemographic, clinical, obstetric, biochemical, and pharmacological parameters were extracted from medical records. Continuous variables are presented as medians (IQRs), and categorical variables are presented as frequencies and percentages. Bivariate analyses were performed via chi-square and Kruskal–Wallis tests, followed by multinomial logistic regression to identify independent predictors of death and progression to chronic kidney disease (CKD) or end-stage kidney disease (ESKD). A p value < 0.05 was considered to indicate statistical significance. Results The mean age of the participants was 32.1 ± 6.6 years, with the majority being aged 31–40 years (48.1%) and married (83.2%). Hypertensive disorders of pregnancy (35.9%) and sepsis (39.3%) were the predominant causes of PRAKI. At diagnosis, 47.7% were pregnant, and 52.3% were postpartum. Most patients (90.7%) were managed conservatively, whereas 10.3% required hemodialysis. The overall renal recovery rate was 51.4%, while 11.2% of the patients progressed to CKD/ESKD, and 37.4% died. Compared with antepartum diagnosis, postpartum presentation was associated with greater recovery ( p  = 0.017). Trimester status, preexisting CKD, malignant hypertension, and intensive care unit (ICU) admission were significantly associated with maternal outcomes ( p  < 0.05). Multinomial regression confirmed pregnancy status and ICU admission as independent predictors of mortality, and preexisting CKD was the strongest predictor of poor renal recovery. Conclusion PRAKI in KATH predominantly affects women in their reproductive prime and is largely driven by preventable hypertensive and septic complications. Despite advances in obstetric care, mortality and incomplete renal recovery remain high. Early identification of high-risk pregnancies, prompt management of hypertensive and infectious complications, and improved access to renal replacement therapy are crucial to reducing the burden of PRAKI and its long-term sequelae in Ghana and similar resource-limited settings.