Objective The study aimed to evaluate the incidence, risk factors, and maternal-fetal outcomes of patients with PRAKI. Design Prospective cross-sectional observational study. Setting Nigeria Population Prgnant women attending anenatal clinic and labour ward of two referal hosiptal in Nigeria. Methods Study conducted among 841 women admitted to the Obstetrics and Gynecology wards of two large referral hospitals in Nigeria, between 1 st October 2022 and 30 th March 2023. Multivariate logistic regression analysis was performed to determine independent predictors of PRAKI. Main Outcome Measures Multivariate logistic regression analysis was performed to determine independent predictors of PRAKI. Results The mean age ± standard deviation (SD) of respondents was 27.8 ± 6.7 years. The prevalence of PRAKI was 11.4%, with the majority (55.2%) being in KDIGO stage 1. The most common risk factors for PRAKI were pre-eclampsia (24%), postpartum hemorrhage (16.7%), sepsis (15.6%), and eclampsia (14.6%). The overall maternal and perinatal mortality rates were 7.4 % and 21.9 %, respectively. PRAKI was independently associated with the use of traditional medications (adjusted odds ratio, aOR =1.94; 95% CI: 1.18, 3.18), history of pregnancy-induced hypertension (aOR = 2.61; 95% CI: 1.49-4.59), and an established diagnosis of hypertension (aOR = 2.53; 95% CI: 1.42, 4.50). Conclusion PRAKI is common in women presenting for care in our setting and is associated with significant maternal and perinatal mortality. The important risk factors for development of PRAKI in our study population include hypertensive disorders of pregnancy, established diagnosis of hypertension, postpartum hemorrhage, and sepsis.