ACUTE KIDNEY INJURY AND PREGNANCY
https://doi.org/10.24884/1561-6274-2018-22-2-39-49
Abstract
Acute kidney injury (AKI) in obstetrics is a serious complication of pregnancy, delivery and the postpartum period, which can have a negative impact on the outcome of pregnancy for both the mother and the fetus. Currently, in developing countries the incidence of AKI during pregnancy and in the postpartum period is 4-26% of all pregnancies, and in the economically developed regions of the world – not more than 2.8%. The frequency of obstetric AKI requiring dialysis is 1:10,000 pregnancies. The causes of kidney injury in pregnant women can be hypertensive disorders, various types of thrombotic microangiopathy (HELLP syndrome, atypical hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura, catastrophic antiphospholipid syndrome), acute fatty liver of pregnancy, obstetric hemorrhages, sepsis and septic shock. The article discusses the diagnostic criteria, biomarkers and timing of development of AKI in pregnancy, the principles of treatment and prevention of this complication in obstetrics.
About the Author
E. I. Prokopenko
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation
Russian Federation
Elena I. Prokopenko, MD, PhD, DSci, Department of transplantology, nephrology and artificial organs
129110 Russia, Moscow, Shchepkin st., 61/2
References
1. Смирнов АВ, Каюков ИГ, Добронравов ВА, Кучер АГ. Острое почечное повреждение и острая почечная недостаточность: некоторые уроки международных инициатив. Нефрология 2008; 12(3): 7–12 [Smirnov AV, Kajukov IG, Dobronravov VA, Kucher AG. Ostroe pochechnoe povrezhdenie i ostraja pochechnaja nedostatochnost': nekotorye uroki mezhdunarodnyh iniciativ. Nefrologija. 2008; 12(3): 7–12]
2. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012; 1:1–126
3. Нефрология. Клинические рекомендации. Шилов Е.М., Смирнов А.В., Козловская Н.Л., ред. ГЭОТАР-Медиа, М., 2016; 816 с [Nefrologija. Klinicheskie rekomendacii. Shilov E.M., Smirnov A.V., Kozlovskaya N.L., red. GEOTAR-Media, M., 2016; 816 s]
4. Najar MS, Shah AR, Wani IA et al. Pregnancy related acute kidney injury: a single center experience from the Kashmir Valley. Indian J Nephrol 2008; 18: 159–161
5. Ganesan C, Maynard SE. Acute kidney injury in pregnancy: the thrombotic microangiopathies. J Nephol 2011; 24(5): 554–563. doi: 10.5301/JN.2011.6250
6. Mehrabadi A, Liu SL, Bartholomew S, Hutcheon JA et al. Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada: population based retrospective cohort study. BMJ 2014; 349: g4731
7. Arrayhani M, El Youbi R, Sqalli T. Pregnancy-related acute kidney injury: experience of the Nephrology Unit at the University Hospital of Fez, Morocco. ISRN Nephrol 2013; doi: 10.5402/2013/109034
8. Acharya A, Santos J, Linde B, Anis K. Acute kidney injury in pregnancy-current status. Adv Chronic Kidney Dis 2013; 20(3): 215–222. doi: 10.1053/j.ackd.2013.02.002
9. Hildebrand AM, Liu K, Shariff SZ et al. Characteristics and outcomes of AKI treated with dialysis during pregnancy and the postpartum period. J Am Soc Nephrol 2015; 26(12): 3085–3091. doi: 10.1681/ASN.2014100954
10. Lunn MR, Obedin-Maliver J, Hsu CY. Increasing incidence of acute kidney injury: also a problem in pregnancy? Am J Kidney Dis 2015; 65(5): 650–654. doi: 10.1053/j.ajkd.2014.11.007
11. Jim B, Garovic VD. Acute kidney injury in pregnancy. Semin Nephrol 2017; 37(4): 378–385. doi: 10.1016/j.semnephrol.2017.05.010
12. Machado S, Figueiredo N, Borges A et al. Acute kidney injury in pregnancy: a clinical challenge. J Nephrol 2012; 25(1): 19–30 . doi: 10.5301/jn.5000013
13. Hou S., Peano C. Acute renal failure in pregnancy. Saudi J Kidney Dis Transpl 1998; 9(3): 261–266
14. Khanal N, Ahmed E, Akhtar F. Epidemiology, causes and outcome of obstetric acute kidney injury. In: Vijayakumar S, ed. Novel insights on chronic kidney disease, acute kidney injury and polycystic kidney disease. Rijeka, InTech, 2012; 67–81
15. Alsuwaida A. Challenges in diagnosis and treatment of acute kidney injury during pregnancy. Nephrourol Mon 2012; 4(1): 340–344. doi: 10.5812/kowsar.22517006.1608
16. Rahman S, Gupta RD, Islam N et al. Pregnancy related acute renal failure in a tertiary care hospital in Bangladesh. J Med 2012; 13: 129–132. doi: 10.3329/jom.v13i2.12739
17. Prakah J. The kidney in pregnancy: a journey of three decades. Indian J Nephrol 2012; 22: 159–167. doi: 10.4103/0971-4065.98750
18. Bentata Y, Housni B, Mimouni A et al. Acute kidney injury related to pregnancy in developing countries: etiology and risk factors in an intensive care unit. J Nephrol 2012; 25(5): 764–775. doi: 10.5301/jn.5000058
19. Aggarwal RS, Mishra VV, Jasani AF, Gumber M. Acute renal failure in pregnancy: our experience. Saudi J Kidney Dis Transpl 2014; 25(2): 450–455. PMID: 24626025
20. Krishna A, Singh R, Prasad N et al. Maternal, fetal and renal outcomes of pregnancy-associated acute kidney injury requiring dialysis. Indian J Nephrol 2015; 25(2): 77–81. doi: 10.4103/0971-4065.136890
21. Jeon DS, Kim TH, Lee HH, Byun DW. Acute renal failure during pregnancy. Open J Nephrol 2013; 3: 11–12. doi:10.4236/ojneph.2013.31003
22. Thomas M, Blaine C, Dawnay A et al. The definition of acute kidney injury and its use in practice. Kidney Int 2015;87:62–73. doi: 10.1038/ki.2014.328
23. Schetz M, Gunst J, Van den Berghe G. The impact of using estimated GFR versus creatinine clearance on the evaluation of recovery from acute kidney injury in the ICU. Intensive Care Med 2014;40(11):1709–1717. doi: 10.1007/s00134-014-3487-1
24. Macedo E, Bouchard J, Soroko SH et al. Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care 2010;14:R82. doi: 10.1186/cc9004
25. Saxena AR, Ananth Karumanchi S, Fan SL et al. Correlation of cystatin-C with glomerular filtration rate by inulin clearance in pregnancy. Hypertens Pregnancy 2012; 31(1): 22–30. doi: 10.3109/10641955.2010.507845
26. Ostermann M, Joannidis M. Acute kidney injury 2016: diagnosis and diagnostic workup. Critical Care 2016; 20:299. doi 10.1186/s13054-016-1478-z
27. Patel ML, Sachan R, Gangwar R et al. Correlation of serum neutrophil gelatinase-associated lipocalin with acute kidney injury in hypertensive disorders of pregnancy. Int J Nephrol Renovasc Dis 2013; 6: 181–186. doi: 10.2147/IJNRD.S45523
28. Sachan R, Patel M, Gaurav A et al. Correlation of serum neutrophil gelatinase associated lipocalin with disease severity in hypertensive disorders of pregnancy. Adv Biomed Res 2014;3:223. doi: 10.4103/2277-9175.145690
29. Moyake N, Buchmann E, Crowther NJ. Neutrophil gelatinase-associated lipocalin as a diagnostic marker of acute kidney injury in pre-eclampsia. J Obstet Gynaecol Res 2016;42(11):1483–1488. doi: 10.1111/jog.13088
30. Xiao J, Niu J, Ye X. et al. Combined biomarkers evaluation for diagnosing kidney injury in preeclampsia. Hypertens Pregnancy 2013; 32(4): 439–449. doi: 10.3109/10641955.2013.827203
31. Fakhouri F, Vercel C, Fr´emeaux-Bacchi V. Obstetric nephrology: AKI and thrombotic microangiopathies in pregnancy. Clin J Am Soc Nephrol 2012; 7: 2100–2106. doi: 10.2215/CJN.13121211
32. Fakhouri F, Roumenina L, Provot F et al. Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations. J Am Soc Nephrol 2010; 21: 859–867. doi: 10.1681/ASN.2009070706
33. Bruel A, Kavanagh D, Noris M et al. Hemolytic uremic syndrome in pregnancy and post-partum. Clin J Am Soc Nephrol 2017: 12. doi: https://doi.org/10.2215/CJN.00280117
34. Patel ML, Sachan R, Radheshyam N, Sachan P. Acute renal failure in pregnancy: tertiary centre experience from north Indian population. Niger Med J 2013; 54(3): 191–195. doi: 10.4103/0300-1652.114586
35. Hassan I, Junejo AM, Dawani ML. Etiology and outcome of acute renal failure in pregnancy. J Coll Physicians Surg Pak 2009; 19: 714–717. doi: 11.2009/JCPSP.714717
36. Frimat M, Decambron M, Lebas C et al. Renal cortical necrosis in postpartum hemorrhage: a case series. Am J Kidney Dis 2016; 68(1): 50–57. doi: 10.1053/j.ajkd.2015.11.022
37. Ермоленко ВМ, Николаев АЮ. Острая почечная недостаточность: руководство. ГЭОТАР-Медиа, M., 2010; 240 с [Ermolenko VM, Nikolaev AJu. Ostraja pochechnaja nedostatochnost': rukovodstvo. GEOTAR-Media, M., 2010; 240 s]
38. Kumar KS, Krishna CR, Kumar VS. Pregnancy related acute renal failure. J Obstet Gynecol India 2006; 56(4): 308–310
39. Huerta A, Arjona E, Portoles J et al. A retrospective study of pregnancy-associated atypical hemolytic uremic syndrome. Kidney Int 2017 Sep 11. pii: S0085-2538(17)30482-9. doi: 10.1016/j.kint.2017.06.022
40. Prakash J, Ganiger VC. Acute kidney injury in pregnancyspecific disorders. Indian J Nephrol 2017; 27(4):258–270. doi: 10.4103/0971-4065.202406
41. Goodwin TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am 2008; 35(3): 401–417, viii. doi: 10.1016/j.ogc.2008.04.002
42. Sahay M. Acute kidney injury in pregnancy. In: Sahay M, ed. Basic nephrology and acute kidney injury. Rijeka, InTech, 2012; 151–172
43. Srinil S, Panaput T. Acute kidney injury complicating septic unsafe abortion: clinical course and treatment outcomes of 44 cases. J Obstet Gynaecol Res 2011; 37(11): 1525–1531. doi: 10.1111/j.1447-0756.2011.01567.x
44. Ozimek JA, Eddins RM, Greene N et al. Opportunities for improvement in care among women with severe maternal morbidity. Am J Obstet Gynecol 2016; 215(4): 509.e1-6. doi: 10.1016/j.ajog.2016.05.022
45. Гипертензивные расстройства во время беременности, в родах и послеродовом периоде. Преэклампсия. Эклампсия. Клинические рекомендации (Протокол лечения). М., 2016; 73 с [Gipertenzivnye rasstrojstva vo vremja beremennosti, v rodah i poslerodovom periode. Prejeklampsija. Jeklampsija. Klinicheskie rekomendacii (Protokol lechenija). M., 2016; 73 s]
46. Козловская НЛ, Меркушева ЛИ, Кирсанова ТВ и др. Влияние дисбаланса плацентарных факторов ангиогенеза на клинические проявления «ранней» и «своевременной» преэклампсии. Нефрология и диализ 2013; 15(3): 206–215 [Kozlovskaja NL, Merkusheva LI, Kirsanova TV i dr. Vlijanie disbalansa placentarnyh faktorov angiogeneza na klinicheskie projavlenija «rannej» i «svoevremennoj» prejeklampsii. Nefrologija i dializ. 2013; 15(3): 206–215]
47. Никольская ИГ, Прокопенко ЕИ, Ватазин АВ, Будыкина ТС. Ангиогенные и антиангиогенные факторы у беременных с хронической болезнью почек: роль коэффициента sFlt-1/PlGF в прогнозировании и диагностике преэклампсии. Нефрология и диализ 2016; 18(4): 440–451 [Nikol’skaja IG, Prokopenko EI, Vatazin AV, Budykina TS. Angiogennye i antiangiogennye faktory u beremennyh s hronicheskoj bolezn’ju pochek: rol’ kojefficienta sFlt-1/PlGF v prognozirovanii i diagnostike prejeklampsii. Nefrologija i dializ 2016; 18(4): 440–451]
48. Gurnadi JI, Mose J, Handono B et al. Difference of concentration of placental soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PIGF), and sFlt-1/PIGF ratio in severe preeclampsia and normal pregnancy. Bio Med Central 2015; 8: 534–538. doi: 10.1186/s13104-015-1506-0
49. Herrais I, Simon E, Gomez-Arriaga PI et al. Angiogenesisrelated biomarkers (sFlt-1/PIGF) in the prediction and diagnosis of placental dysfunction: an approach for clinical integration. Int J Mol Sci 2015; 16: 19009–19026. doi: 10.3390/ijms160819009
50. Eiland E, Nzerue C, Faulkner M. Preeclampsia 2012. J Pregnancy 2012; 2012:586578. doi: 10.1155/2012/586578
51. Magee LA, Pels A, Helewa M et al. Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014; 36(5): 416–441
52. Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy. National Collaborating Centre for Women’s and Children’s Health (UK). London, RCOG Press; 2010
53. Mu J, Zhang J, Sunnassee A, Dong H. A case report of undiagnosed postpartum hemolytic uremic syndrome. Diagn Pathol 2015; 10: 89. doi: 10.1186/s13000-015-0278-0
54. Козловская НЛ, Коротчаева ЮВ. Атипичный гемолитико-уремический синдром в акушерской практике: первый российский опыт диагностики и лечения. Российский вестник акушера-гинеколога 2016; 16(6): 95–104 [Kozlovskaja NL, Korotchaeva JuV. Atipichnyj gemolitiko-uremicheskij sindrom v akusherskoj praktike: pervyj rossijskij opyt diagnostiki i lechenija. Rossijskij vestnik akushera-ginekologa. 2016; 16(6): 95–104]
55. George JN, Nester CM, McIntosh JJ. Syndromes of thrombotic microangiopathy associated with pregnancy. Hematology Am Soc Hematol Educ Program 2015; 2015: 644–648. doi: 10.1182/asheducation-2015.1.644
56. Bergmann F, Rath W. The differential diagnosis of thrombocytopenia in pregnancy. Dtsch Arztebl Int 2015; 112(47): 795–802. doi: 10.3238/arztebl.2015.0795
57. Sadler JE. Von Willebrand factor, ADAMTS13, and thrombotic thrombocytopenic purpura. Blood 2008; 112(1):11–18. doi: 10.1182/blood-2008-02-078170
58. Volokhina EB, Westra D, van der Velden TJ et al. Complement activation patterns in atypical haemolytic uraemic syndrome during acute phase and in remission. Clin Exp Immunol 2015; 181(2): 306–313. doi: 10.1111/cei.12426
59. Westra D, Volokhina E, van der Heijden E et al. Genetic disorders in complement (regulating) genes in patients with atypical haemolytic uraemic syndrome (aHUS). Nephrol Dial Transplant 2010; 25(7): 2195–2202. doi: 10.1093/ndt/gfq010
60. Campistol JM, Arias M, Ariceta G. An update for atypical haemolytic uraemic syndrome: diagnosis and treatment. A consensus document. Nefrologia 2015; 35(5):421–447. doi: 10.1016/j.nefro.2015.07.005
61. Прокопенко ЕИ, Лихванцев ВВ, Ватазин АВ и др. Атипичный гемолитико-уремический синдром, ассоциированный с беременностью: жизнеспасающая терапия экулизумабом. Клиническая нефрология 2016: 3–4: 63–68 [Prokopenko EI, Lihvancev VV, Vatazin AV i dr. Atipichnyj gemolitiko-uremicheskij sindrom, associirovannyj s beremennost’ju: zhiznespasajushhaja terapija jekulizumabom. Klinicheskaja nefrologija 2016: 3–4: 63–68]
62. Barber MA, Eguiluz I, Martín A et al. Acute fatty liver of pregnancy: analysis of five consecutive cases from a tertiary centre. J Obstet Gynaecol 2010; 30(3):241–243. doi: 10.3109/01443610903452765
63. Sahai S, Kiran R. Acute liver failure in pregnancy: causative and prognostic factors. Saudi J Gastroenterol 2015; 21(1):30–34. doi: 10.4103/1319-3767.151221
64. Sepulveda-Martinez A, Romero C, Juarez G. Causes and management of severe acute liver damage during pregnancy. Rev Med Chil 2015; 143(5):627–636. doi: 10.4067/S0034-98872015000500011
65. Siribamrungwong M, Chinudomwong P. Relation between acute kidney injury and pregnancy-related factors. J Aс Dis 2016; 5(1): 22–28. doi:10.1016/j.joad.2015.08.002
66. Papafragkakis H, Singhal S, Anand S. Acute fatty liver of pregnancy. South Med J 2013;106(10): 588–593. doi: 10.1097/SMJ.0000000000000007
67. Westbrook RH, Yeoman AD, Joshi D. Outcomes of severe pregnancy-related liver disease: refining the role of transplantation. Am J Transplant 2010;10(11): 2520–2526. doi: 10.1111/j.1600-6143.2010.03301.x
68. Mahesh E, Puri S, Varma V. et al. Pregnancy-related acute kidney injury: An analysis of 165 cases. Indian J Nephrol 2017; 27(2): 113–117. doi: 10.4103/0971-4065.194394
69. Септические осложнения в акушерстве. Клинические рекомендации (протокол лечения) утв. МЗ РФ 6 февраля 2017 г. Москва, 2017; 59 с. [Septicheskie oslozhnenija v akusherstve. Klinicheskie rekomendacii (protokol lechenija) utv. MZ RF 6 fevralja 2017 g. Moskva, 2017. 59 s.]
70. Al-Ostad G, Kezouh A, Spence AR, Abenhaim HA. Incidence and risk factors of sepsis mortality in labor, delivery and after birth: population-based study in the USA. J Obstet Gynaecol Res 2015; 41(8):1201–1206. doi: 10.1111/jog.12710
71. Galvão A, Braga AC, Gonçalves DR et al. Sepsis during pregnancy or the postpartum period. J Obstet Gynaecol 2016; 36(6): 735–743
72. Acharya A. Management of acute kidney injury in pregnancy for the obstetrician. Obstet Gynecol Clin North Am 2016; 43(4): 747–765. doi: 10.1016/j.ogc.2016.07.007
73. Wiles KS, Banerjee A. Acute kidney injury in pregnancy and the use of non-steroidal anti-inflammatory drugs. Obstet Gynecol 2016; 18 (2):127–135
74. Ibarra-Hernández M, Orozco-Guillén OA, de la AlcantarVallín ML et al. Acute kidney injury in pregnancy and the role of underlying CKD: a point of view from México. J Nephrol 2017; 30(6): 773–780. doi: 10.1007/s40620-017-0444-4
Review
For citations:
Prokopenko E.I. ACUTE KIDNEY INJURY AND PREGNANCY. Nephrology (Saint-Petersburg). 2018;22(2):39-49. (In Russ.) https://doi.org/10.24884/1561-6274-2018-22-2-39-49
Views:
6311
Email this article 