Acute kidney injury during pregnancy in kidney transplant recipients

Abstract

Pregnancy‐related acute kidney injury (AKI) is a public health problem and remains an important cause of maternal and fetal morbidity and mortality. The incidence of pregnancy‐related AKI has increased in developed countries due to increase in maternal age and higher detection rates. Pregnancy in women with kidney transplants is associated with higher adverse outcomes like preeclampsia, preterm births, and allograft dysfunction, but limited data exists on causes and outcomes of pregnancy‐related AKI in the kidney transplant population. Diagnosis of AKI during pregnancy remains challenging in kidney transplant recipients due to lack of diagnostic criteria. Management of pregnancy‐related AKI in the kidney transplant population requires a multidisciplinary team consisting of transplant nephrologists, high‐risk obstetricians, and neonatologists. In this review, we discuss pregnancy‐related AKI in women with kidney transplants, etiologies, pregnancy outcomes, and management strategies.

Cover Image

“…1 The allograft's placement makes it prone to compression from the gravid uterus, and thus AKI. 2 Our patient had preconception counseling and optimization, with excellent allograft function (creatinine 0.8 mg/dl, no proteinuria), no recent episodes of rejection or sickling, and discontinued teratogenic mycophenolate before conception. Although the pregnancy was complicated by hydronephrosis, preeclampsia, and proteinuria, a multidisciplinary team approach resulted in a successful outcome.…”

Azathioprine associated with intrahepatic cholestasis in a patient with twin pregnancy after a second kidney transplant

“…Pregnancy is a state of immunological tolerance associated with decreased immune activity of lymphocytes, which creates tolerance to the foetus and may benefit the kidney allograft. However, there is a possibility that the antigenic stimulus provided by the foetus may trigger graft rejection as well [12] . Having said that, acute rejection rates are similar to the general transplant population -about 9.0% during pregnancy and 1.3% postpartum [13] .…”

Indoxyl Sulfate Administration during Pregnancy Contributes to Renal Injury and Increased Blood–Brain Barrier Permeability

“…PR-AKI has been reported to be associated with an increased risk of cardiovascular events, mortality, and adverse renal outcomes; however, there is much to understand about PR-AKI's short-and long-term effects on the central nervous system and the brain [3,15]. Clinical and rodent studies have indicated that AKI in a non-pregnant state is associated with increased risk of CKD, and the progression of AKI to CKD is associated with increased circulating I.S.…”