Acute kidney injury in pregnancy: a clinical challenge

Machado, Susana; Figueiredo, Nuno; Borges, Andreia; Pais, Maria; Freitas, Luís Carlos Bastos; Moura, Paulo; Campos, Mário

doi:10.5301/jn.5000013

Cited by 65 publications

(93 citation statements)

References 94 publications

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“…[5][6][7] However, it is still common during pregnancy in developing countries and being responsible for a high maternal morbidity and mortality rate. In the same line, Susan et al [8] reported that "in spite of the significant reduction of incidence of acute kidney injury in pregnancy over the second half of the 20th century, it is still associated with major maternal and perinatal morbidity and mortality" A set of systemic and renal physiological adaptive mechanisms occur during a normal gestation clarifies the possibility of acquiring acute kidney injury that will oblige several changes in laboratory parameters of renal function, electrolytes, fluid and acid-base balances. Susan et al [8].…”

Section: Introductionsupporting

confidence: 63%

“…In the same line, Susan et al [8] reported that "in spite of the significant reduction of incidence of acute kidney injury in pregnancy over the second half of the 20th century, it is still associated with major maternal and perinatal morbidity and mortality" A set of systemic and renal physiological adaptive mechanisms occur during a normal gestation clarifies the possibility of acquiring acute kidney injury that will oblige several changes in laboratory parameters of renal function, electrolytes, fluid and acid-base balances. Susan et al [8]. These changes are presented in the increase in kidney size by about 1-1.5 cm due to renal vascular and interstitial space volume expansion that lead to over 90% of pregnant women develop a physiological hydronephrosis of pregnancy [9].…”

Section: Introductionsupporting

confidence: 63%

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The risk factors and outcome of early identified acute kidney injury among critically ill obstetric patients

El-Hafez

Mahjoub

Ahmad

2017

IJANS

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Background: Acute kidney injury (AKI) is one of the most challenging and serious complications of pregnancy and postpartum period that facing critical care nurses in Intensive Care Unit (ICU). Having a uniform standard for identifying and classifying AKI would enhance critical care nurses' ability to recognize these patients and leading to better outcomes. Objective: This work aimed to explore the risk factors and outcome of early identified acute kidney injury of critically obstetric patients in Obstetric ICU. Design. A descriptive cross sectional research design was used in this study. Participants: A total sample of 338 women admitted to Obstetric ICU at Woman Health Hospital, Assiut City, Egypt. Method: Three tools were used.Tool I was developed by the researcher and included demographic and obstetric history, lab parameters, complications and outcomes arising from AKI. The Sequential Organ Failure Assessment (SOFA) score as tool II to determine the extent of a patient's organ function or rate of failure. Measurement of serum creatinine and urine output were used to early identify AKI stages according to Acute Kidney Injury Network (AKIN) Criteria (tool III). Results: The prevalence of AKI among obstetric patients admitted to obstetric ICU was 10.1%; of them 52.9% needed renal replacement therapy and the mortality rate was 29.4%. Postpartum hemorrhage was the most common cause of AKI and its prevalence was 41.2%. It was also found that 74.5% of AKI patients developed complications. Conclusion: AKI complicated 10.1% of total admitted women to the OICU in the studied period. Postpartum hemorrhage represents the most prevalent risk factors with a highly significant SOFA score compared to other risk factors as sever preeclampsia, eclampsia, HEELP & APH with acute fatty liver.

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Section: Introductionsupporting

confidence: 63%

Section: Introductionsupporting

confidence: 63%

The risk factors and outcome of early identified acute kidney injury among critically ill obstetric patients

El-Hafez

Mahjoub

Ahmad

2017

IJANS

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“…17 However, the use of this classification, which focuses on the plasma creatinine percentage change and on the development of oliguria, is not consensual and further studies are needed to demonstrate its usefulness in pregnant women. 2 In our study, main causes responsible of PRARF were preeclampsia (66.5%) and acute bleeding (27.8%) while septic events were incriminated in only 4.2% of the cases. This may be explained by the fact that the Tunisian legislation allows abortion during the first three months of pregnancy since 1965.…”

Section: Discussionmentioning

confidence: 96%

“…In fact, since 1960, the incidence of this complication has been reduced significantly, and currently affects 1 per 15,000-20,000 pregnancies. 1,2 Available data in the literature dealing with this topic are very heterogeneous as different definitions were proposed, ranging from serum creatinine levels of 40.8 mg/dL to daily dialysis requirement. 1 Moreover, epidemiologic data of pregnancyrelated acute renal failure (PRARF) in developing countries are scanty and may differ from those of developed countries where the legislation of abortion have lead to the reduction in the number of septic abortion.…”

Section: Introductionmentioning

confidence: 99%

Acute renal failure and pregnancy: a seventeen-year experience of a Tunisian intensive care unit

et al. 2013

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To describe the epidemiologic features of acute renal failure related to pregnancy (PRARF) and to evaluate its prognostic impact. Methods: Retrospective study conducted in a Tunisian intensive care unit over a period of 17 years (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011). Women were included if they were more than 20 weeks pregnant and were admitted to the ICU during pregnancy or immediately (57 d) post partum. PRARF was defined by a serum creatinine level 40.8 mg/dL and was classified as mild (0.9 to 1.4 mg/dL), moderate (1.5 to 2.9 mg/dL) or severe (43 mg/dL). Results: Five hundred and fifty patients were included. Mean age was 31 AE 6 years. Mean SOFA score was 4 AE 3. PRARF was diagnosed in 313 patients (56.9%). ARF was mild in 215 cases (39.1%), moderate in 65 cases (11.8%) and severe in 33 cases (6%). Main causes leading to this complication were preeclampsia (66.5%) and acute hemorrhage (27.8%). Only two patients (0.4%) developed chronic renal failure and needed long-term dialysis. Patients who developed this complication had higher SOFA score (4.7 AE 3.5 vs. 3.2 AE 2.1; p50.001). Thirty-three patients (6%) died in the ICU. The rate of ICU mortality was significantly higher in patients with PRARF (9.3 vs. 1.7%; p50.001). Conclusions: PRARF is associated with higher mortality. Thus, appropriate monitoring of pregnancies is needed in order to prevent its onset by an early and prompt management of the underlying risk factors.

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“…Несмотря на то что во время беременности ТМА развивается редко (в структуре всех форм ТМА на долю акушерской ТМА -А-ТМА -приходится 8-18%), высокие риск развития преэклампсии, материнская и пе-ринатальная смертность, неблагоприятный «почечный» прогноз, ассоциированный с этой патологией, обусловли-вают актуальность изучения данной проблемы [1,2].…”

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Atypical hemolytic-uremic syndrome in obstetric practice: The first Russian experience of diagnosis and treatment

Kozlovskaya¹,

Korotchaeva²

2016

Ross. vestn. akush.-ginekol.

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1 Кафедра нефрологии и гемодиализа Первого Московского государственного медицинского университета им. И.М. Сеченова Минздрава россии, Москва, россия; 2 научно-исследовательский отдел нефрологии Первого Московского государственного медицинского университета им. И.М. Сеченова Минздрава россии, Москва, россия атипичный гемолитико-уремический синдром в 12-31% случаев связан с беременностью или родами и может опреде-лять прогноз жизни как матери, так и ребенка. Цель работы -анализ клинических проявлений, особенностей течения и исходов атипичного гемолитико-уремического синдрома у беременных и родильниц. Материал и методы. С 2012 по 2016 г. наблюдались 20 пациенток в возрасте от 19 до 38 лет, у которых атипичный гемолитико-уремический синдром развился во время беременности или непосредственно после родов. Результаты. развитию указанного синдрома предше-ствовали преимущественно преэклампсия и/или hEllP-синдром и другие акушерские осложнения, диарея. Все пациентки имели полный симптомокомплекс тромботической микроангиопатии: резкое снижение уровня гемоглобина (66±16,77 г/л) с признаками микроангиопатического гемолиза (повышение уровня лДг -2953,16±3185,17 ед/л, шизоцитоз), тромбо-цитопению (52,5±33,2 тыс. в мкл), острое повреждение почек (гиперкреатининемия -466,3±212,4 мкмоль/л, олигурия или анурия). у 16 (80%) из 20 пациенток впервые отмечена артериальная гипертензия. у всех пациенток тромботическая микроангиопатия носила системный характер: признаки поражения печени и легких имели по 75% женщин (15 из 20) соответственно, поражение цнС отмечалось у 70% (14 из 20), сердца -у 40% (8 из 20). При анализе течения ати-пичного гемолитико-уремического синдрома в зависимости от сроков беременности на момент развития заболевания клинико-лабораторные показатели были измененными в большей степени у женщин с манифестацией синдрома в III три-местре и после родов. лечение состояло преимущественно из плазмотерапии в режимах инфузий свежезамороженной плазмы и плазмообмена -у 16 (80%) пациенток из 20, 8 пациенткам было начато лечение экулизумабом -препаратом, являющимся моноклональным антителом против компонента С5 системы комплемента. Материнская летальность соста-вила 35%. Выводы. «акушерский» атипичный гемолитико-уремический синдром характеризуется развитием полиорган-ной недостаточности у большинства пациенток. развитию синдрома предшествуют различные комплемент-активирующие состояния. По-видимому, именно осложнения беременности, а не сама беременность при нормальном ее течении явля-ются триггерами атипичного гемолитико-уремического синдрома у женщин с генетической предрасположенностью к его развитию.авторы информируют об отсутствии конфликта интересов.Ключевые слова: тромботическая микроангиопатия, атипичный гемолитико-уремический синдром, беременность, преэклампсия, HELLP-синдром.

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Acute kidney injury in pregnancy: a clinical challenge

Cited by 65 publications

References 94 publications

The risk factors and outcome of early identified acute kidney injury among critically ill obstetric patients

The risk factors and outcome of early identified acute kidney injury among critically ill obstetric patients

Acute renal failure and pregnancy: a seventeen-year experience of a Tunisian intensive care unit

Atypical hemolytic-uremic syndrome in obstetric practice: The first Russian experience of diagnosis and treatment

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