Acute Renal Failure in Pregnancy

Abstract

Poster Presentation Background Acute renal failure is a rare, life‐threatening complication of severe preeclampsia and hemolysis elevated liver enzymes and low platelets syndrome (HELLP). This condition occurs in an estimated 1 in 20000 pregnancies. Acute renal failure presents challenges for even the expert nurse. The purpose of this presentation is to assist obstetric nurses in recognizing complications of severe preeclampsia such as acute renal failure and empower them with the knowledge and skills to manage women with this condition to improve outcomes. Case A 25‐year‐old G1P0 woman at 39 weeks gestation arrived in our obstetric triage unit with complaints of a constant headache, visual disturbances, epigastric pain, and contractions for one hour. Initial blood pressure was 190/125 and fetal heart tones were not present on auscultation. After immediate notification to the obstetric (OB) triage attending physician, an intravenous line (IV) was started, lab work was drawn, IV antihypertensive medication was administered, and a magnesium sulfate infusion was started. After evaluation, the woman was diagnosed with an intrauterine fetal demise secondary to superimposed preeclampsia and HELLP syndrome. She was admitted to our labor and delivery unit for induction of labor. Within 24 hours of admission, maternal/fetal medicine, nephrology, neurology, and optometry were consulted. During induction, lab work was ordered every 4 hours and disseminated intravascular coagulation (DIC) was diagnosed, which required multiple blood transfusions. Urine output was minimal and renal lab values were elevated with an initial creatinine of 1.6 that peaked at 7.6. The woman required the placement of a tunnel catheter and dialysis short term while in the hospital. She continued to have complaints of visual disturbances and was diagnosed with retinal detachment related to DIC and preeclampsia. The woman was discharged one week postpartum on oral antihypertensive medication after her course of dialysis was completed. Conclusion Management of this woman with superimposed preeclampsia and HELLP syndrome with complications of DIC and acute renal failure presented a challenge to our health care team. Management required a multidisciplinary team approach to prevent further deterioration of kidney function and kidney disease. Acute renal failure was identified early by the health care team. The collaboration of the health care team and their ability to utilize each other's knowledge and expertise resulted in the woman being on dialysis short term, restoration of her kidney function, and her discharge on oral antihypertensive medication.