Acute kidney injury in pregnancy

Abstract

The diagnosis of acute kidney injury in pregnancy is complicated by physiological changes to both kidney and circulation; although a serum creatinine of higher than 90 μ‎‎‎mol/L is considered diagnostic of kidney injury in pregnancy. The aetiology of acute kidney injury in pregnancy mirrors that of the non-pregnant patient with the addition of pregnancy-specific conditions such as pre-eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes, low platelets), post-partum haemorrhage, and acute fatty liver of pregnancy. In early pregnancy, the major additional concerns are septic abortion and hyperemesis. Urinary tract infection is common in pregnancy. Surveillance and treatment thresholds reflect the recognized association between urinary tract infection and adverse pregnancy outcome. Obstructive nephropathy is difficult to diagnose in pregnancy due to a physiological dilatation of the renal tract. Radiological assessment and intervention to the renal tract in pregnancy are also discussed in this chapter.