Abstract
Acute kidney injury (AKI) is costly and is associated with increased mortality and morbidity. An understanding of the renal physiologic changes that occur during pregnancy is essential for proper evaluation, diagnosis, and management of AKI. As in the general population, AKI can occur from prerenal, intrinsic, and post-renal causes. Major causes of pre-renal azotemia include hyperemesis gravidarum and uterine hemorrhage in the setting of placental abruption. Intrinsic etiologies include infections from acute pyelonephritis and septic abortion, bilateral cortical necrosis, and acute tubular necrosis. Particular attention should be paid to specific conditions that lead to AKI during the second and third trimesters, such as preeclampsia, HELLP syndrome, acute fatty liver of pregnancy, and TTP-HUS. For each of these disorders, delivery of the fetus is the recommended therapeutic option, with additional therapies indicated for each specific disease entity. An understanding of the various etiologies of AKI in the pregnant patient is key to the appropriate clinical management, prevention of adverse maternal outcomes, and safe delivery of the fetus. In pregnant women with pre-existing kidney disease, the degree of renal dysfunction is the major determining factor of pregnancy outcomes, which may further be complicated by a prior history of hypertension.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 478-486 |
| Number of pages | 9 |
| Journal | Clinical Nephrology |
| Volume | 78 |
| Issue number | 6 |
| DOIs | |
| State | Published - 2012 |
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Keywords
- Acute kidney injury (AKI)
- ahus (atypical hemolytic uremic syndrome)
- elevated liver enzymes
- HELLP (hemolysis
- Low platelets)
- TMA (thrombotic microangiopathy)
- TTP-HUS (thrombotic thrombocytopenic purpura-Hemolytic uremic syndrome)
ASJC Scopus subject areas
- Nephrology
Cite this
Acute kidney injury in the pregnant patient. / Nwoko, Rosemary; Plecas, Darko; Garovic, Vesna D.
In: Clinical Nephrology, Vol. 78, No. 6, 2012, p. 478-486.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Acute kidney injury in the pregnant patient
AU - Nwoko, Rosemary
AU - Plecas, Darko
AU - Garovic, Vesna D
PY - 2012
Y1 - 2012
N2 - Acute kidney injury (AKI) is costly and is associated with increased mortality and morbidity. An understanding of the renal physiologic changes that occur during pregnancy is essential for proper evaluation, diagnosis, and management of AKI. As in the general population, AKI can occur from prerenal, intrinsic, and post-renal causes. Major causes of pre-renal azotemia include hyperemesis gravidarum and uterine hemorrhage in the setting of placental abruption. Intrinsic etiologies include infections from acute pyelonephritis and septic abortion, bilateral cortical necrosis, and acute tubular necrosis. Particular attention should be paid to specific conditions that lead to AKI during the second and third trimesters, such as preeclampsia, HELLP syndrome, acute fatty liver of pregnancy, and TTP-HUS. For each of these disorders, delivery of the fetus is the recommended therapeutic option, with additional therapies indicated for each specific disease entity. An understanding of the various etiologies of AKI in the pregnant patient is key to the appropriate clinical management, prevention of adverse maternal outcomes, and safe delivery of the fetus. In pregnant women with pre-existing kidney disease, the degree of renal dysfunction is the major determining factor of pregnancy outcomes, which may further be complicated by a prior history of hypertension.
AB - Acute kidney injury (AKI) is costly and is associated with increased mortality and morbidity. An understanding of the renal physiologic changes that occur during pregnancy is essential for proper evaluation, diagnosis, and management of AKI. As in the general population, AKI can occur from prerenal, intrinsic, and post-renal causes. Major causes of pre-renal azotemia include hyperemesis gravidarum and uterine hemorrhage in the setting of placental abruption. Intrinsic etiologies include infections from acute pyelonephritis and septic abortion, bilateral cortical necrosis, and acute tubular necrosis. Particular attention should be paid to specific conditions that lead to AKI during the second and third trimesters, such as preeclampsia, HELLP syndrome, acute fatty liver of pregnancy, and TTP-HUS. For each of these disorders, delivery of the fetus is the recommended therapeutic option, with additional therapies indicated for each specific disease entity. An understanding of the various etiologies of AKI in the pregnant patient is key to the appropriate clinical management, prevention of adverse maternal outcomes, and safe delivery of the fetus. In pregnant women with pre-existing kidney disease, the degree of renal dysfunction is the major determining factor of pregnancy outcomes, which may further be complicated by a prior history of hypertension.
KW - Acute kidney injury (AKI)
KW - ahus (atypical hemolytic uremic syndrome)
KW - elevated liver enzymes
KW - HELLP (hemolysis
KW - Low platelets)
KW - TMA (thrombotic microangiopathy)
KW - TTP-HUS (thrombotic thrombocytopenic purpura-Hemolytic uremic syndrome)
UR - http://www.scopus.com/inward/record.url?scp=84871563181&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871563181&partnerID=8YFLogxK
U2 - 10.5414/CN107323
DO - 10.5414/CN107323
M3 - Article
C2 - 23164415
AN - SCOPUS:84871563181
VL - 78
SP - 478
EP - 486
JO - Clinical Nephrology
JF - Clinical Nephrology
SN - 0301-0430
IS - 6
ER -