Acute kidney injury in the pregnant patient

Rosemary Nwoko, Darko Plecas, Vesna D Garovic

Research output: Contribution to journalArticle

13 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)478-486
Number of pages9
JournalClinical Nephrology
Volume78
Issue number6
DOIs
StatePublished - 2012

Fingerprint

Acute Kidney Injury
Kidney
Fetus
Necrosis
Septic Abortion
Hyperemesis Gravidarum
HELLP Syndrome
Azotemia
Abruptio Placentae
Preexisting Condition Coverage
Uterine Hemorrhage
Pyelonephritis
Kidney Diseases
Third Pregnancy Trimester
Second Pregnancy Trimester
Pregnancy Outcome
Pre-Eclampsia
Pregnant Women
Mothers
Hypertension

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 journalArticle

Nwoko, Rosemary ; Plecas, Darko ; Garovic, Vesna D. / Acute kidney injury in the pregnant patient. In: Clinical Nephrology. 2012 ; Vol. 78, No. 6. pp. 478-486.
@article{4d9d504a33004843af0432c25f63fc5d,
title = "Acute kidney injury in the pregnant patient",
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.",
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)",
author = "Rosemary Nwoko and Darko Plecas and Garovic, {Vesna D}",
year = "2012",
doi = "10.5414/CN107323",
language = "English (US)",
volume = "78",
pages = "478--486",
journal = "Clinical Nephrology",
issn = "0301-0430",
publisher = "Dustri-Verlag Dr. Karl Feistle",
number = "6",

}

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 -