A woman who survives a severe pre-eclampsia pregnancy in Zambia or Sierra Leone faces a one-in-49 lifetime risk of maternal death—partly because undetected kidney damage silently progresses to chronic disease, and postnatal follow-up is often nonexistent. This study tackles a vicious cycle: pre-eclampsia causes pregnancy-associated kidney injury, which then increases the risk of pre-eclampsia in future pregnancies ten-fold. In low-income countries, maternity care is overstretched, laboratory reagents for detecting kidney injury are scarce, and barriers like transport costs and family responsibilities prevent women from returning for check-ups. The researchers will measure how many women develop persistent kidney disease after pre-eclampsia, test simple point-of-care diagnostic tools that work without a lab, and assess whether ultrasound-guided fluid management can prevent acute kidney injury from becoming chronic. If successful, this work could transform postnatal care in resource-poor settings. Cheap, portable tests and straightforward fluid management protocols could be deployed in clinics with minimal training, breaking the pre-eclampsia–kidney disease cycle. The findings will inform a larger randomised trial; if that trial shows benefit, the intervention could rapidly reduce maternal mortality in the countries where the risk is highest.
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Pre-eclampsia is a leading cause of maternal mortality and morbidity, including pregnancy-associated kidney injury (PRAKI) and chronic kidney disease (CKD). CKD impacts future pregnancy outcomes, increasing the risk of developing pre-eclampsia ten-fold. In settings where maternity care is already overstretched, this vicious cycle compounds the increased lifetime risk of maternal death (1 in 49) for a woman living in a low-income country compared to a high-income country (1 in 5300). Prevention and early detection of CKD postnatally is therefore key to implementing timely treatment and may enable targeted interventions to reduce the risk of long-term complications. This is challenging in resource-poor settings where lack of laboratory reagents limit clinicians' ability to detect kidney injury and barriers to accessing care such as financial resources, transport, family responsibilities and cultural preferences mean that postnatal follow-up is often lacking. This study aims to address the current gaps in evidence, by ascertaining the proportion of women who develop persistent kidney disease following a pregnancy complicated by pre-eclampsia, evaluate novel point-of-care tests to improve the detection and diagnosis of kidney disease in these settings, and assess early interventions including ultrasound-guided fluid management to prevent AKI and consequent CKD, in women with pre-eclampsia in Zambia and Sierra Leone. This study will inform the design of a larger randomised trial evaluating a co-developed complex intervention, which, if shown to be beneficial, has the potential to rapidly improve immediate maternal mortality.
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