Abstract
Pregnancy-related acute kidney injury (PR-AKI) is a heterogeneous disorder with multiple aetiologies that can occur at any time throughout pregnancy and the post-partum period. PR-AKI is an important obstetric complication that is associated with significant maternal and foetal morbidity and mortality. Although there has been an overall decline in the incidence of PR-AKI worldwide, a recent shift in the occurrence of this disease has been reported. Following improvements in obstetric care, PR-AKI incidence has been reduced in developing countries, whereas an increase in PR-AKI incidence has been reported in developed countries. Awareness of the physiological adaptations of the renal system is essential for the diagnosis and management of kidney impairment in pregnancy. In this review we scrutinize the factors that have contributed to the changing epidemiology of PR-AKI and discuss challenges in the diagnosis and management of acute kidney injury (AKI) in pregnancy from an obstetrics perspective. Thereafter we provide brief discussions on the diagnostic approach of certain PR-AKI aetiologies and summarize key therapeutic measures.
Highlights
The ability of the body to adapt to the physiologic alterations of pregnancy is attenuated in women with kidney diseases or systemic diseases affecting the kidney
It is essential that the team providing care are familiar with systemic and renal physiological adaptive mechanisms, laboratory parameters in pregnancy, and are knowledgeable on the mainstay therapeutic measures to be initiated in the context of suspected or actual pregnancy-related acute kidney injury (PR-AKI)
This review provides an overview of the changing epidemiological and clinical landscape of acute kidney injury in pregnancy, followed by specific discussions on recent recommendations in the approach to the management of this cohort of women
Summary
The ability of the body to adapt to the physiologic alterations of pregnancy is attenuated in women with kidney diseases or systemic diseases affecting the kidney. A variety of disorders cause acute kidney injury (AKI) in early or late pregnancy, with pre-eclampsia and pregnancy-induced hypertensive disorders being the most common etiology [1]. It is essential that the team providing care are familiar with systemic and renal physiological adaptive mechanisms, laboratory parameters in pregnancy, and are knowledgeable on the mainstay therapeutic measures to be initiated in the context of suspected or actual pregnancy-related acute kidney injury (PR-AKI). Recent published literature demonstrates the increased awareness of kidney injury in pregnancy and the management of PR-AKI, with focus on the important relationship between pre-eclampsia, pregnancy-induced hypertensive disorders, thrombotic angiopathies, and AKI [1,6,7,8,9]. This review provides an overview of the changing epidemiological and clinical landscape of acute kidney injury in pregnancy, followed by specific discussions on recent recommendations in the approach to the management of this cohort of women
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