Acute kidney injury in the pregnant patient

Nwoko, Rosemary; Plecas, Darko; Garovic, Vesna D.

doi:10.5414/cn107323

Cited by 35 publications

(28 citation statements)

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“…The incidence of pregnancy related acute kidney injury (PR-AKI) has decreased markedly worldwide during the past 50 years, probably due to improvement of obstetric and prenatal care as well as decline in rate of illegal abortion [1, 2]. However in recent years, the rate of PR-AKI appears to be on the rise even in some developed countries [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis

Liu

Zheng

et al. 2017

BMC Pregnancy Childbirth

119

102

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BackgroundPresently, the matter of pregnancy outcomes of patients with pregnancy related AKI (PR-AKI) were disputed. Thus, we conducted a meta-analysis to evaluate the impact of PR-AKI on pregnancy outcomes.MethodWe systematically searched MEDLINE, Embase, VIP, CNKI and Wanfang Databases for cohort or case-control studies in women with PR-AKI and those without AKI as a control group to assess the influence of PR-AKI on pregnancy outcomes and kidney outcome. Reduction of odd ratio (OR) was calculated by a random-effects model.ResultsOne thousand one hundred fifty two articles were systematically reviewed, of those 11 studies were included, providing data of 845 pregnancies in 834 women with PR-AKI and 5387 pregnancies in 5334 women without AKI. In terms of maternal outcomes, women with PR-AKI had a greater likelihood of cesarean delivery (OR, 1.49; 95% confidence interval [CI], 1.37 to 1.61), hemorrhage (1.26; 1.02 to 1.56), HELLP syndrome (1.86; 1.41 to 2.46), placental abruption (3.13; 1.96 to 5.02), DIC (3.41; 2.00 to 5.84), maternal death (4.50; 2.73 to 7.43), but had a lower risk of eclampsia (0.53; 0.34 to 0.83). Women with PR-AKI also had a longer stay in ICU (weighted mean difference, 2.13 day [95% CI 1.43 to 2.83 day]) compared with those without PR-AKI. As for fetal outcomes, higher incidence of stillbirth/perinatal death (3.39, 2.76 to 4.18), lower mean gestational age at delivery (−0.70 week [95% CI -1.21 to −0.19 week]) and lower birth weight (−740 g [95% CI -1180 to 310 g]) were observed in women with PR-AKI. The occurrence of kidney outcome, defined as ESRD requiring dialysis, in women with PR-AKI was 2.4% (95% CI 1.3% to 4.2%).ConclusionsPR-AKI remains a grave complication and has been associated with increased maternal and fetal mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1402-9) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis

Liu

Zheng

et al. 2017

BMC Pregnancy Childbirth

119

102

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“…32,33 The syndrome was first described in 1982 by Weinstein and colleagues 34 as being characterized by hemolysis, low platelets and elevated liver enzymes. It is associated with significant maternal morbidity and mortality.…”

Section: Complications Of Hypertensive Pregnancymentioning

confidence: 99%

“…35,36 HELLP syndrome must be differentiated from hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenia purpura (TTP), two forms of thrombotic microangiopathy that may present during pregnancy. 33 TTP and HUS, either typical or atypical, are not characterized by elevated liver enzymes and, in addition, TTP is associated with deficiency in the enzyme ADAMTS13, a metalloproteinase that degrades von Willebrand factor multimers.…”

Section: Complications Of Hypertensive Pregnancymentioning

confidence: 99%

The Management of Hypertension in Pregnancy

Kattah

Garovic

2013

Advances in Chronic Kidney Disease

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132

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Hypertensive pregnancy disorders complicate 6–8% of pregnancies and cause significant maternal and fetal morbidity and mortality. The goal of treatment is to prevent significant cerebrovascular and cardiovascular events in the mother, without compromising fetal well-being. Current guidelines differentiate between the treatment of women with acute hypertensive syndromes of pregnancy and women with preexisting chronic hypertension in pregnancy. This review will address the management of hypertension in pregnancy, review the various pharmacologic therapies, and discuss the future directions in this field.

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“…increase in serum creatinine by 0.3 mg/dl (26.5 μmol/l) within 48 hours or increase in serum creatinine to 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or urine volume of <0.5ml/kg/hour for 6 hours. 1 The renal changes may be only temporary, and resolve within a few weeks postpartum, or may become irreversible leading to a progression of chronic kidney disease(CKD). 2,3 Pre-eclampsia/ eclampsia is the most common cause of AKI during pregnancy and purperium, however, the outcome of pre-eclampsia related AKI is good.…”

Section: Introductionmentioning

confidence: 99%

A study of pregnancy related acute kidney injury and its outcome at a tertiary care centre, civil hospital, Ahmadabad, Gujarat, India

Agrawal

Jain

2019

Int J Reprod Contracept Obstet Gynecol

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Background: Pregnancy related acute kidney injury (PRAKI) is acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of PRAKI is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity of diagnosis and management. A multi discipilinary team is often needed to optimize all aspects of the pregnant women’s care.Methods: To study association and contributing factors in pregnancy related Acute Kidney injury, a retrospective study of 39 cases of acute kidney injury complicating pregnancies was carried out in department of obstetrics and gynaecology, B. J. Medical college over a period of 6 months, and results were studied and analysed. Etiological-factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and results were tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF in pregnancy was found to be 0.3%. Hypertension and its related complications were the most common causative factor. 59.5% of cases required hemodialysis and except for 6 cases (14.3%) all had complete or at least partial recovery from failure.Conclusions: AKI complicating pregnancies are not uncommon in tertiary care centres. If recognized and treated promptly, recovery is assured in majority of 85.7% of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of ARF cases.

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Acute kidney injury in the pregnant patient

Cited by 35 publications

References 0 publications

Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis

Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis

The Management of Hypertension in Pregnancy

A study of pregnancy related acute kidney injury and its outcome at a tertiary care centre, civil hospital, Ahmadabad, Gujarat, India

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