PURPOSE:
Pregnancy-associated acute kidney injury (PrAKI) remains a silent contributor to maternal morbidity and mortality in low-resource settings, often arising from preventable causes like obstetric haemorrhage. This case study illustrates the long-term consequences of missed opportunities for early detection and intervention.

DISCUSSION:
A 20-year-old G2P2 woman, developed end-stage kidney disease following severe postpartum haemorrhage and delayed management after a vaginal birth in a tertiary facility in Zambia. Despite early signs of uterine atony and scanty urine output post-delivery, she was discharged without adequate monitoring or follow-up. Persistent anuria was culturally normalised, and health-seeking was delayed by informal advice and poor access to diagnostic services. Eventually, she re-presented in critical condition with severe anaemia, oedema, and fluid overload, requiring emergency dialysis. Renal ultrasound confirmed irreversible kidney damage, and she now requires long-term haemodialysis three times weekly. Systemic barriers, including fragmented referral systems, delayed diagnosis, inadequate documentation, and health insurance access issues, further compounded her recovery. The impact on her mental, social, and economic well-being has been profound, including prolonged separation from her newborn.

EVIDENCE WHERE RELEVANT:
This case underscores the importance of postpartum surveillance, particularly fluid balance and urine output monitoring. Midwives play a vital role in early detection and escalation. The absence of routine renal function monitoring and specialised care pathways for PrAKI in maternity care results in preventable long-term disability.

KEY MESSAGE:
PrAKI is preventable. Investing in midwife-led surveillance, prompt recognition of complications, improved documentation, and equitable access to renal care can save lives and preserve futures. Complications - other