The Changing Landscape of Acute Kidney Injury in Pregnancy from an Obstetrics Perspective

Abstract

Pregnancy-related acute kidney injury (PR-AKI) is a heterogeneous disorder with multiple aetiologies that can occur at any time throughout pregnancy and the post-partum period. PR-AKI is an important obstetric complication that is associated with significant maternal and foetal morbidity and mortality. Although there has been an overall decline in the incidence of PR-AKI worldwide, a recent shift in the occurrence of this disease has been reported. Following improvements in obstetric care, PR-AKI incidence has been reduced in developing countries, whereas an increase in PR-AKI incidence has been reported in developed countries. Awareness of the physiological adaptations of the renal system is essential for the diagnosis and management of kidney impairment in pregnancy. In this review we scrutinize the factors that have contributed to the changing epidemiology of PR-AKI and discuss challenges in the diagnosis and management of acute kidney injury (AKI) in pregnancy from an obstetrics perspective. Thereafter we provide brief discussions on the diagnostic approach of certain PR-AKI aetiologies and summarize key therapeutic measures.

Acute kidney injury during pregnancy in kidney transplant recipients

“…These can be the early indicators of AKI due to graft dysfunction, acute rejection, and recurrent or de novo glomerulonephritis. Different etiologies for AKI can be classified according to different stages of pregnancy, 18 although there might be a significant overlap during each trimester (Table 1).…”

“…Most of these pregnancy-related AKI etiologies overlap with the general population, while some are specific to the kidney transplant population. 6,18,21 During the second and third trimesters, the causes of AKI are more specific to an isolated pregnancy-related complication in the kidney transplant population. These include preeclampsia, hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome, acute fatty liver of pregnancy, thrombotic microangiopathies like thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome, renal vein thrombosis, and urinary tract infection.…”

“…ture, blood culture, and specific serologies should be done when suspected based on history and clinical presentation. 6,18,21 Acute pyelonephritis: Gestational pyelonephritis is a serious condition associated with premature labor, intrauterine growth restriction, sepsis, and AKI. Kidney transplant recipients are inherently at a higher risk for urinary tract infections and hence higher risk for AKI from pyelonephritis, especially with a gravid uterus and increased urinary reflux.…”

Sobrecarga hídrica de pacientes con complicaciones obstétricas que requieren terapia de reemplazo renal continua

“…[4][5][6] www.medigraphic.org.mx La sobrecarga hídrica es un problema en particular difícil en la paciente obstétrica, ya que ésta tiene cierto grado de disfunción respiratoria debido al aumento en la presión intraabdominal, situación que se complica debido a la disminución del volumen intravascular, la hemodilución, el aumento del gasto cardiaco, el estado de hiperfiltración glomerular, el edema en los diferentes tejidos así como los cambios a nivel hemorreológico. 7 Se ha demostrado que la sobrecarga hídrica ≥ 10% del peso corporal se asocia con un incremento en la mortalidad de 40-60%. 4 Genera además disfunción orgánica, que se ve reflejada en una estancia prolongada en la UCI y más días de ventilación mecánica asistida (VMA).…”

Acute Renal Problems Still a Great Challenge in Obstetrics

“…It is a complex multietiology involving condition that can take place during pregnancy and at postpartum periods at any time. It is a serious obstetric complication associated with severe foetomaternal mortality and morbidity [3]. The incidence has declined due to improvements in reproductive health but it is still correlated with significant perinatal mortality and maternal morbidity [4].…”