Acute kidney injury in pregnancy and the use of non‐steroidal anti‐inflammatory drugs

Abstract

Key content Serum creatinine falls in normal pregnancy and a new serum creatinine level above 90 micromol/l in pregnancy should trigger investigation for acute kidney injury. Causes of acute kidney injury in pregnancy include pre‐eclampsia, HELLP (haemolysis, elevated liver enzymes and low platelet count), microangiopathic haemolytic anaemia, acute fatty liver of pregnancy, lupus nephritis, renal tract obstruction and drug use. Non‐steroidal anti‐inflammatory drugs (NSAIDs) can cause acute kidney injury as well as cardiovascular and gastrointestinal adverse effects. NSAIDs should be avoided in pre‐eclampsia, volume depletion, acute kidney injury and chronic kidney disease. When NSAIDs are used, ibuprofen has the best safety profile. It should be used at the lowest effective dose and discontinued as soon as possible. Learning objectives To be able to diagnose acute kidney injury in pregnancy and understand the importance of supportive treatment. To gain an overview of the possible causes of acute kidney injury in pregnancy and their management. To appreciate the adverse effect profile of NSAIDs and be able to modify prescribing for high‐risk patients. Ethical issues When prescribing in pregnancy and the postpartum period the risks and benefits of treatment must be considered for each individual patient. Acute kidney injury in pregnancy is more prevalent in low and middle income countries where there is often a lower provision of supportive renal care.