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Acute Renal Failure (Acute Kidney Injury) in Pregnancy

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Principles of Critical Care in Obstetrics

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Abstract

Acute renal failure (ARF or acute kidney injury [AKI]) in pregnancy is characterized by a rapid decrease in the glomerular filtration rate (GFR) over a matter of minutes or days. It may result from many of the same causes that occur in nonpregnant women. However, there are specific conditions in pregnancy that may precipitate ARF [1]. Understanding the causes of renal functional deterioration in pregnancy is important in arriving at a rational differential diagnosis and initiating appropriate treatment. In pregnancy, development of ARF is a major clinical challenge because it affects both mother and fetus. Management options, therefore, need to take both maternal and fetal well-being into consideration. Prevention, early recognition, and appropriate therapeutic decisions are imperative in improving maternal and perinatal outcomes. ARF in pregnancy is a complex entity, requiring a multidisciplinary approach with the nephrologist playing an important role.

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References

  1. Krane NK. Acute renal failure in pregnancy. Arch Intern Med. 1988;148(11):2347.

    Article  CAS  PubMed  Google Scholar 

  2. Stratta P, Besso L, Canavese C, Grill A, Todros T, Benedetto C, et al. Is pregnancy-related acute renal failure a disappearing clinical entity? Ren Fail. 1996;18:575–84.

    Article  CAS  PubMed  Google Scholar 

  3. Prakash J, Kumar H, Sinha DK, Kedalaya PG, Pandey LK, Srivastava PK, et al. Acute renal failure in pregnancy in a developing country: twenty years of experience. Ren Fail. 2006;28:309–13.

    Article  PubMed  Google Scholar 

  4. Prakash J, Tripathi K, Pandey LK, Sahai S, Usha, Srivastava PK. Spectrum of renal cortical necrosis in acute renal failure in eastern India. Postgrad Med J. 1995;71:208–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kumar KS, Krishna CR, Siva Kumar V. Pregnancy related acute renal failure. J Obstet Gynecol India. 2006;56:308–10.

    Google Scholar 

  6. Goplani KR, Shah PR, Gera DN, et al. Pregnancy-related acute renal failure: a single-center experience. Indian J Nephrol. 2008;18(1):17–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. August P, George JN. Acute kidney injury (acute renal failure) in pregnancy. Lockwood CJ, Palevsky PM, editors. In: UpToDate. Waltham: UpToDate; 2014. Accessed 14 Nov 2014.

    Google Scholar 

  8. Machado S, Figueiredo N, Borges A, et al. Acute kidney injury in pregnancy: a clinical challenge. J Nephrol. 2012;25(01):21–30.

    Article  Google Scholar 

  9. Chugh KS, Singhal PC, Sharma BK. ARF of obstetric origin. J Obstet Gynecol. 1976;108:253–61.

    Google Scholar 

  10. Prakash J, Tripathi K, Pandey LK, Gadela SR, Usha. Renal cortical necrosis in pregnancy related acute renal failure. J Indian Med Assoc. 1996;94:227–9.

    CAS  PubMed  Google Scholar 

  11. Report of the ACOG Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5).

    Google Scholar 

  12. Leeman L, Fontaine P. Hypertensive disorders of pregnancy. Am Fam Physician. 2008;78(1):93–100.

    PubMed  Google Scholar 

  13. Lafayette RA, Druzin M, Sibley R, et al. Nature of glomerular dysfunction in pre-eclampsia. Kidney Int. 1998;54:1240.

    Article  CAS  PubMed  Google Scholar 

  14. Sibai BM, Ramadan MK. Acute renal failure in pregnancies complicated by hemolysis, elevated liver enzymes, and low platelets. Am J Obstet Gynecol. 1993;168:1682.

    Article  CAS  PubMed  Google Scholar 

  15. Picinni P, Gallo G. Diagnosis and management of HELLP syndrome. In: Ronco C, Bellomo R, Kellum J, editors. Critical care nephrology. 2nd ed. Philadelphia: Saunders; 2009. p. 337–40.

    Google Scholar 

  16. Baxter JK, Weinstein L. HELLP syndrome: the state of the art. Obstet Gynecol Surv. 2004;59(12):838–45.

    Article  PubMed  Google Scholar 

  17. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management: a Review. BMC Pregnancy Childbirth. 2009;9(1):8. 65.

    Google Scholar 

  18. Drakeley AJ, Le Roux PA, Anthony J, Penny J. Acute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit. Am J Obstet Gynecol. 2002;186(2):253–6.

    Article  PubMed  Google Scholar 

  19. Gul A, Aslan H, Cebeci A, Polat I, Ulusoy S, Ceylan Y. Maternal and fetal outcomes in HELLP syndrome complicated with acute renal failure. Ren Fail. 2004;26(5):557–62.

    Article  PubMed  Google Scholar 

  20. Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103(5 Pt 1):981–91.

    Article  PubMed  Google Scholar 

  21. Castro MA, Fassett MJ, Reynolds TB, et al. Reversible peripartum liver failure: a new perspective on the diagnosis, treatment, and cause of acute fatty liver of pregnancy, based on 28 consecutive cases. Am J Obstet Gynecol. 1999;181:389.

    Article  CAS  PubMed  Google Scholar 

  22. Santana L, Hernández Medina E, O’Shanahan G, Sánchez-Palacios M. Acute renal failure in acute fatty liver of pregnancy: apropos of a case. Nefrologia. 2005;25(4):453–4.

    CAS  PubMed  Google Scholar 

  23. Koroshi A, Babameto A. Acute renal failure during acute fatty liver of pregnancy. Nephrol Dial Transplant. 2002;17(6):1110–2.

    Article  PubMed  Google Scholar 

  24. Guntupalli SR, Steingrub J. Hepatic disease and pregnancy: an overview of diagnosis and management. Crit Care Med. 2005;33(10 Suppl):S332–9.

    Article  PubMed  Google Scholar 

  25. Nelson DB, Yost NP, Cunningham FG. Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery. Am J Obstet Gynecol. 2013;209:456.e1.

    Article  Google Scholar 

  26. Fakhouri F, Frémeaux-Bacchi V. Does hemolytic uremic syndrome differ from thrombotic thrombocytopenic purpura? Nat Clin Pract Nephrol. 2007;3(12):679–87.

    Article  PubMed  Google Scholar 

  27. George J. The thrombotic thrombocytopenic purpura and hemolytic uremic syndrome: evaluation, management and long-term outcomes experience of the Oklahoma TTP-HUS registry, 1989–2007. Kidney Int. 2009;112:S52–4.

    Article  Google Scholar 

  28. 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(5):859–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Drakely AJ, Le Roux PA, Anthony J, Penny J. Acute renal failure complicating severe preeclampsia requiring admission to an obstetric intensive care unit. Am J Obstet Gynecol. 2002;186:253–6.

    Article  Google Scholar 

  30. Prakash J, Niwas SS, Parekh A, et al. Acute kidney injury in late pregnancy in developing countries. Ren Fail. 2010;32(3):309–13.

    Article  PubMed  Google Scholar 

  31. Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013;17:204.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Podymow T, August P. Update on the use of antihypertensive drugs in pregnancy. Hypertension. 2008;51:960–9.

    Article  CAS  PubMed  Google Scholar 

  33. Visintin C, Mugglestone MA, Almerie MQ, Nherera LM, James D, Walkinshaw S. Management of hypertensive disorders during pregnancy: summary of NICE guidance. BMJ. 2010;341:c2207.

    Article  PubMed  Google Scholar 

  34. Vidaeff AC, Carroll MA, Ramin SM. Acute hypertensive emergencies in pregnancy. Crit Care Med. 2005;33:S307–12.

    Article  PubMed  Google Scholar 

  35. Magee LA, Cham C, Waterman EJ, Ohlsson A, von Dadelszen P. Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ. 2003;327:955–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Chandiramani M, Shennan A. Hypertensive disorders of pregnancy: a UK-based perspective. Curr Opin Obstet Gynecol. 2008;20:96–101.

    Article  PubMed  Google Scholar 

  37. Machado S, Figueiredo N, Borges A, et al. Acute kidney injury in pregnancy: a clinical challenge. J Nephrol. 2012;25:19–30.

    Article  PubMed  Google Scholar 

  38. Acharya A, Santos J, Linde B, Anis K. Acute kidney injury in pregnancy-current status. Adv Chronic Kidney Dis. 2013;20:215–22.

    Article  PubMed  Google Scholar 

  39. Tanhehco YC, Berns JS. Red blood cell transfusion risks in patients with end-stage renal disease. Semin Dial. 2012;25:539–44.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Jungers P, Chauveau D. Pregnancy in renal disease. Kidney Int. 1997;52:871–85.

    Article  CAS  PubMed  Google Scholar 

  41. Barraclough K, Leone E, Chiu A. Renal replacement therapy for acute kidney injury in pregnancy. Nephrol Dial Transplant. 2007;22:2395–7.

    Article  PubMed  Google Scholar 

  42. Davison JM, Dunlop W. Renal hemodynamics and tubular function normal human pregnancy. Kidney Int. 1980;18:152–61.

    Article  CAS  PubMed  Google Scholar 

  43. Sturgiss SN, Dunlop W, Davison JM. Renal haemodynamics and tubular function in human pregnancy. Baillieres Clin Obstet Gynaecol. 1994;8:209–34.

    Article  CAS  PubMed  Google Scholar 

  44. Bagon JA, Vernaeve H, De Muylder X, Lafontaine JJ, Martens J, Van Roost G. Pregnancy and dialysis. Am J Kidney Dis. 1998;31:756–65.

    Article  CAS  PubMed  Google Scholar 

  45. Gangji AS, Windrim R, Gandhi S, Silverman JA, Chan CT. Successful pregnancy with nocturnal hemodialysis. Am J Kidney Dis. 2004;44:912–6.

    Article  PubMed  Google Scholar 

  46. Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patients. Am J Kidney Dis. 1998;31:766–73.

    Article  CAS  PubMed  Google Scholar 

  47. Hladunewich MA, Hou S, Odutayo A, et al. Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison. J Am Soc Nephrol. 2014;25:1103–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Krane NK, Hamrahian M. Pregnancy: kidney diseases and hypertension. Am J Kidney Dis. 2007;49:336–45.

    Article  PubMed  Google Scholar 

  49. Davenport A. Peritoneal dialysis in acute kidney injury. Perit Dial Int. 2008;28:423–4; author reply 424.

    CAS  PubMed  Google Scholar 

  50. Briones-Garduno JC, Diaz de Leon-Ponce MA, Rodriguez-Roldan M, Briones-Vega CG, Torres-Perez J. Peritoneal dialysis in obstetric patients. Cir Cir. 2006;74:15–20.

    PubMed  Google Scholar 

  51. Hou S. Modification of dialysis regimens for pregnancy. Int J Artif Organs. 2002;25:823–6.

    CAS  PubMed  Google Scholar 

  52. Fieghen HE, Friedrich JO, Burns KE, et al. The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury. BMC Nephrol. 2010;11:32.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Hill JB, Yost NP, Wendel GDJ. Acute renal failure in association with severe hyperemesis gravidarum. Obstet Gynecol. 2002;100:1119–21.

    PubMed  Google Scholar 

  54. Blackwell SC, Redman ME, Tomlinson M, et al. Labor induction for the preterm severe pre-eclamptic patient: is it worth the effort? J Matern Fetal Med. 2001;10:305–11.

    Article  CAS  PubMed  Google Scholar 

  55. Gammill HS, Jeyabalan A. Acute renal failure in pregnancy. Crit Care Med. 2005;33(10 Suppl):S372–84.

    Article  PubMed  Google Scholar 

  56. Bushnell C, Chireau M. Preeclampsia and stroke: risks during and after pregnancy. Stroke Res Treat. 2011;2011:858134.

    PubMed  PubMed Central  Google Scholar 

  57. Dennis AT, Solnordal CB. Acute pulmonary oedema in pregnant women. Anaesthesia. 2012;67:646–59.

    Article  CAS  PubMed  Google Scholar 

  58. Churchill D, Duley L, Thornton JG, Jones L. Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks’ gestation. Cochrane Database Syst Rev. 2013;(7):CD003106.

    Google Scholar 

  59. Group TETC. Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet. 1995;345:1455–63.

    Article  Google Scholar 

  60. Chugh KS, Jha V, Sakhuja V, Joshi K. Acute renal cortical necrosis–a study of 113 patients. Ren Fail. 1994;16:37–47.

    Article  CAS  PubMed  Google Scholar 

  61. Esplin MSM, Branch DW. Diagnosis and management of thrombotic microangiopathies during pregnancy. Clin Obstet Gynecol Ambul Gynecol. 1999;42:360–7.

    Article  CAS  Google Scholar 

  62. Rock G, Shumak KH, Buskard MA, et al. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. N Engl J Med. 1991;325:393–7.

    Article  CAS  PubMed  Google Scholar 

  63. Fakhouri F, Vercel C, Fremeaux-Bacchi V. Obstetric nephrology: AKI and thrombotic microangiopathies in pregnancy. Clin J Am Soc Nephrol. 2012;7:2100–6.

    Article  PubMed  Google Scholar 

  64. Kremer Hovinga JA, Vesely SK, Terrell DR, Lammle B, George JN. Survival and relapse in patients with thrombotic thrombocytopenic purpura. Blood. 2010;115:1500–11; quiz 1662.

    Article  PubMed  Google Scholar 

  65. Gall B, Yee A, Berry B, et al. Rituximab for management of refractory pregnancy-associated immune thrombocytopenic purpura. J Obstet Gynaecol Can. 2010;32:1167–71.

    Article  PubMed  Google Scholar 

  66. Chakravarty EF, Murray ER, Kelman A, Farmer P. Pregnancy outcomes after maternal exposure to rituximab. Blood. 2011;117:1499–506.

    Article  CAS  PubMed  Google Scholar 

  67. Kaplan M. Eculizumab (Alexion). Curr Opin Investig Drugs. 2002;3:1017–23.

    CAS  PubMed  Google Scholar 

  68. Mache CJ, Acham-Roschitz B, Fremeaux-Bacchi V, et al. Complement inhibitor eculizumab in atypical hemolytic uremic syndrome. Clin J Am Soc Nephrol. 2009;4:1312–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Legendre CM, Licht C, Muus P, et al. Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome. N Engl J Med. 2013;368:2169–81.

    Article  CAS  PubMed  Google Scholar 

  70. Kelly R, Arnold L, Richards S, et al. The management of pregnancy in paroxysmal nocturnal haemoglobinuria on long term eculizumab. Br J Haematol. 2010;149:446–50.

    Article  CAS  PubMed  Google Scholar 

  71. Clark SL. Handbook of critical care obstetrics. Boston: Blackwell Scientific Publications; 1994.

    Google Scholar 

  72. 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(4):159–61.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, E V Kalyani Medical Foundation, 3 Second Street, R K Salai, Chennai, 600004, India

    Gita Arjun FACOG

  2. Department of Medicine, Sundaram Medical Foundation, Dr. Rangarajan Memorial Hospital, Shanthi Colony, 4th Avenue, Anna Nagar West, Chennai, 600 040, India

    M. Sivalingam MRCP(UK), FRCP(Lon)

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  1. Gita Arjun FACOG
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  2. M. Sivalingam MRCP(UK), FRCP(Lon)
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Correspondence to Gita Arjun FACOG .

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Editors and Affiliations

  1. Arihant Women’s Hospital, Ahmedabad, Gujarat, India

    Alpesh Gandhi

  2. Rainbow Healthcare, Agra, India

    Narendra Malhotra

  3. Art Rainbow-IVF, Agra, India

    Jaideep Malhotra

  4. Obstetrics and Gynecology, SN Medical College, Agra, India

    Nidhi Gupta

  5. Bharti Vidya Peethmedical College, Pune, India

    Neharika Malhotra Bora

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Arjun, G., Sivalingam, M. (2016). Acute Renal Failure (Acute Kidney Injury) in Pregnancy. In: Gandhi, A., Malhotra, N., Malhotra, J., Gupta, N., Bora, N. (eds) Principles of Critical Care in Obstetrics. Springer, New Delhi. https://doi.org/10.1007/978-81-322-2686-4_6

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  • DOI: https://doi.org/10.1007/978-81-322-2686-4_6

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