Pregnancy-Associated Kidney Injury

  • A. Eric Anderson
  • Sophia M. Rothberger Lannon


A 23-year-old G1P0000 without prior past medical history is 31 weeks pregnant with prenatal care presents with complaints of worsening leg and face swelling for the past 2 days now seeks care because of headache, diarrhea, nausea, and vomiting. On exam she is found to have a blood pressure of 120/86, edema, and brisk deep tendon reflexes. Laboratory testing revealed hemoglobin 11.3 g/dl, platelet count 141,000/μl white blood count 18,000/μl, creatinine 1.1 mg/dl, aspartate aminotransferases (AST) 65 U/l, lactate dehydrogenase (LDH) 400 U/l, total bilirubin 1.1 mg/dl, prothrombin time (PT) 14.7 s, ammonia of 90 mcg/dl, blood glucose 139 mg/dl, calcium 7.3 mg/dl, and uric acid of 6.0 mg/dl. The urinalysis demonstrated WBC’s 3–5/hpf, RBC’s 3–5/hpf—non-dysmorphic, renal tubular epithelial cells were seen and a urine protein to creatinine ratio of 2. One day after hospitalization the patient’s blood pressure was 145/87 with a similar blood pressure 6 h later.


Acute Kidney Injury Serum Uric Acid Acute Tubular Necrosis Sickle Cell Trait Hyperemesis Gravidarium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Chapman AB, Abraham WT, Zamudio S, Coffin C, Merouani A, Young D, Johnson A, Osorio F, Goldberg C, Moore L, Dahms T, Schrier RW. Temporal relationships between hormonal and hemodynamic changes in early human pregnancy. Kidney Int. 1998;54:2056–63.PubMedCrossRefGoogle Scholar
  2. 2.
    Szecsi PB, Jorgensen M, Klajnbard A, Andersen MR, Colov NP, Stender S. Haemostatic reference intervals in pregnancy. Thromb Haemost. 2010;103:683–873.CrossRefGoogle Scholar
  3. 3.
    Smith MC, Moran P, Ward MK, Davison JM. Assessment of glomerular filtration rate during pregnancy using the MDRD formula. Br J Obstet Gynaecol. 2008;115:109–12.Google Scholar
  4. 4.
    Price CP, Newll RG, Boyd JC. Use of protein: creatinine ratio measurements on random urine samples for prediction of significant proteinuria: a systematic review. Clin Chem. 2005;51(9):1577–86.PubMedCrossRefGoogle Scholar
  5. 5.
    Ganesan C, Maynard SE. Acute kidney injury in pregnancy: the thrombotic microangiopathies. J Nephrol. 2011;24(5):554–63.PubMedCrossRefGoogle Scholar
  6. 6.
    Knight M, Nelson-Piercy C, Kurinczuk JJ. A prospective national study of acute fatty liver of pregnancy in the UK. Gut. 2008;57:951–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Ch’ng CL, Morgan M, Hainsworth I, Kingham JGC. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut. 2002;51:876–80.PubMedCrossRefGoogle Scholar
  8. 8.
    Bellig LL. Maternal acute fatty liver of pregnancy and the associated risk for long-chain 3-hydroxyacyl-coenzyme A dehydrogenase (LCHAD) deficiency in infants. Adv Neonatal Care. 2004;4(1):26–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Davies MH, Elias E. Intrahepatic cholestasis of pregnancy: pathogenesis and management. Trop Gastroeneterol. 1993;14(3):79–86.Google Scholar
  10. 10.
    Smolarczyk R, Wojcicka-Jagodzinska J, Piekaarski P, Romejko E, Czjkowski K. The biochemical functions of the renal tubules and glomeruli in the course of Intrahepatic cholestasis of pregnancy. Eur J Obstet Gynecol Reprod Biol. 2000;89:35–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Bose PB, Das BC, Kumar A, Gondal R, Kumar D, Kar P. High viral load and deregulation of the progesterone receptor signaling pathway: association with hepatitis E-related poor pregnancy outcome. J Hepatol. 2011;54(6):1107–13.PubMedCrossRefGoogle Scholar
  12. 12.
    Norvell JP, Blei AT, Jovanovic BD, Levitsky J. Herpes simplex virus hepatitis: an analysis of the published literature and institutional cases. Liver Transpl. 2007;13:1428–34.PubMedCrossRefGoogle Scholar
  13. 13.
    Thurman RH, Konig K, Watkins A, Weerasiri T, Permezel M. Fulminant herpes simplex virus hepatic failure in pregnancy in pregnancy requiring liver transplantation. Aust N Z J Obstet Gynaecol. 2010;50:491–8.CrossRefGoogle Scholar
  14. 14.
    Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, Ansari A, Baughman KL. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Disease (National Institutes of Health) workshop recommendations and review. JAMA. 2000;283(9):1183–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Demakis JG, Rahimtoola SH, Sutton GC, et al. Natural course of peripartum cardiomyopathy. Circulation. 1971;44:1053–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Patel AM, Goldfarb S. Got calcium? Welcome to the calcium-alkali syndrome. J Am Soc Nephrol. 2010;21:1440–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Kovacs CS, Kronenberg HM. Maternal-fetal calcium and bone metabolism during pregnancy, puerperium and lactation. Endocr Rev. 1997;18:832–72.PubMedCrossRefGoogle Scholar
  18. 18.
    Kolnick L, Harris BD, Choma DP, Choma NN. Hypercalcemia in pregnancy: a case of milk-alkali syndrome. J Gen Intern Med. 2011;26(8):939–42.PubMedCrossRefGoogle Scholar
  19. 19.
    Fill Malfertheiner S, Malfertheiner MV, Monkemuller K, Rohl FW, Malfertheiner P, Costa DS. Gastroesophageal reflux disease and management in advanced pregnancy: a prospective survery. Digestion. 2009;79(2):115–20.PubMedCrossRefGoogle Scholar
  20. 20.
    Thomas AA, Thomas AZ, Campbell SC, Palmer JS. Urologic emergencies in pregnancy. Pediatr Urol. 2010;76:453–60.Google Scholar
  21. 21.
    Swanson SK, Hellman RL, Eversman WG. Urinary tract stones in pregnancy. Surg Clin North Am. 1995;75(1):123–42.PubMedGoogle Scholar
  22. 22.
    Srirangam SJ, Hickerton B, Cleynenbreugel BV. Management of urinary calculi in pregnancy: a review. J Endourol. 2008;22:867–75.PubMedCrossRefGoogle Scholar
  23. 23.
    Stothers L, Lee LM. Renal colic in pregnancy. J Urol. 1992;148(5):1383–7.PubMedGoogle Scholar
  24. 24.
    Chang J, Elam-Evans LD, et al. Pregnancy-related mortality surveillance—United States, 1991–1999. MMWR Surveill Summ. 2003;52(2):1–8.PubMedGoogle Scholar
  25. 25.
    Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335(7627):974.PubMedCrossRefGoogle Scholar
  26. 26.
    Audibert F, Friedman S, Frangieh AY, Sibai BM. Clinical utility of strict diagnostic criteria for the HELLP syndrome. Am J Obstet Gynecol. 1996;175:460–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Spargo BH, McCartney CP, Winemiller R. Glomerular capillary endotheliosis in toxemia of pregnancy. AMA Arch Pathol. 1959;68:593.Google Scholar
  28. 28.
    Hanssens M, Keirse MJ, Spitz B, et al. Angiotensin II levels in hypertensive and normotensive pregnancies. Br J Obstet Gynecol. 1991;98:155.CrossRefGoogle Scholar
  29. 29.
    Brown MA, Zammit VC, Mitar DA, et al. Renin-aldosterone relationships in pregnancy-induced hypertension. Am J Hypertens. 1992;5:366.PubMedGoogle Scholar
  30. 30.
    Valeur-Jensen AK, Pedersen CB, Westergaar T, Jensen IP, Lebech M, Andersen PK, Aaby P, Pedersen BN, Melbye M. Risk factors for parvovirus B19 infection in pregnancy. JAMA. 1999;281(12):1099–105.PubMedCrossRefGoogle Scholar
  31. 31.
    Podymow T, Muhtadie L. Pregnancy-associated parovirus B19 infection causing postinfectious glomerulonephritis. Hypertens Pregnancy. 2010;29(4):429–33.PubMedCrossRefGoogle Scholar
  32. 32.
    Fervenza F, Green A, Lafayett RA. Acute renal failure due to postinfectious glomerulonephritis during pregnancy. Am J Kidney Dis. 1997;29(2):273–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Singson E, Fisher KF, Lindheimer MD. Acute poststreptococcal glomerulonephritis in pregnancy: case report with an 18 year follow-up. Am J Obstet Gynecol. 1980;137:857–8.PubMedGoogle Scholar
  34. 34.
    Kincaid-Smith P, Fairley KF, Bullen M. Kidney disease and pregnancy. Med J Aust. 1967;2:1155–9.Google Scholar
  35. 35.
    Nadler N, Salinas-Madrigal L, Charles AG, Pollak VE. Acute glomerulonephritis during late pregnancy: report of a case. Obstet Gynecol. 1969;34:277–83.PubMedGoogle Scholar
  36. 36.
    Fukuda O, Ito M, Nakayama M, Matsui K, Fujisaki S, Okamura H. Acute glomerulonephritis during the third trimester of pregnancy. Int J Gynecol Obstet. 1988;26:141–4.CrossRefGoogle Scholar
  37. 37.
    Brown MA, Holt JL, Mangos GJ, Murray N, Curtis J, Homer C. Microscopic hematuria in pregnancy: relevance to pregnancy outcome. Am J Kidney Dis. 2005;45(4):667–73.PubMedCrossRefGoogle Scholar
  38. 38.
    Lampley EC, Williams S, Myers SA. Cocaine-associated rhabdomyolysis causing renal failure in pregnancy. Obstet Gynecol. 1996;87(5):804–6.PubMedGoogle Scholar
  39. 39.
    Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007, at (
  40. 40.
    Whalley P. Bacteriuria of pregnancy. Am J Obstet Gynecol. 1967;97:723–38.PubMedGoogle Scholar
  41. 41.
    Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2007;(2):CD000490.Google Scholar
  42. 42.
    Dafnis E, Sabatini S. The effect of pregnancy on renal function: physiology and pathophysiology. Am J Med Sci. 1992;303:184–205.PubMedCrossRefGoogle Scholar
  43. 43.
    Hill JB, Sheffield JS, McIntire DD, Wendel Jr GD. Acute pyelonephritis in pregnancy. Obstet Gynecol. 2005;105:18–23.PubMedCrossRefGoogle Scholar
  44. 44.
    Winslow BT, Voorhees KI, Pehl KA. Methamphetamine abuse. Am Fam Physician. 2007;76:1169–74.PubMedGoogle Scholar
  45. 45.
    Pregnancy and substance use. NSDUH Report January 2 2004, at
  46. 46.
    Groteut CA, Dandolu V, Katari S, Whiteman VE, Geifman-Holtzman O, Teitelman M. Baking soda pica: a case of hypokalemic metabolic alkalosis and rhabdomyolysis in pregnancy. Obstet Gynecol. 2006;107(2 Pt2):484–6.Google Scholar
  47. 47.
    Slater PM, Grivell R, Cyna AM. Labour management of a woman with carnitine palmitoyl transferase type 2 deficiency. Anaesth Intensive Care. 2009;37:305–8.PubMedGoogle Scholar
  48. 48.
    Sun PM, Wilbrun W, Raynor BD, Jamieson D. Sickle cell disease in pregnancy: twenty years of experience at Grady Memorial Hospital, Atlanta, Georgia. Am J Obstet Gynecol. 2001;184(6):1127–30.PubMedCrossRefGoogle Scholar
  49. 49.
    Villers MS, Jamison MG, De Castro LM, James AH. Morbidity associated with sickle cell disease in pregnancy. Am J Obstet Gynecol. 2008;199:125. e1–125.e5.PubMedCrossRefGoogle Scholar
  50. 50.
    Hassell K. Pregnancy and sickle cell disease. Hematol Oncol Clin North Am. 2005;19:903–16.PubMedCrossRefGoogle Scholar
  51. 51.
    Alexopoulos E, Tampakoudis P, Bili H, Mantalenakis S. Acute uric acid nephropathy in pregnancy. Obstet Gynecol. 1992;80:488–9.PubMedGoogle Scholar
  52. 52.
    Verriello L, D’Amico D, Pauletto G, Gigli GL, Bergonzi P. Rhabomyolysis caused by tocolytic therapy with Ritodrine hydrochloride. Neuromuscul Disord. 2009;19:718–20.PubMedCrossRefGoogle Scholar
  53. 53.
    Matsuda Y, Nagayoshi Y, Kirihara N. Rhabdomyolysis during prolonged intravenous tocolytic therapy. J Perinat Med. 2002;30(6):476–9.PubMedGoogle Scholar
  54. 54.
    Ditzian-Kadanoff R, Reinhard JD, Thomas C, Segal AS. Polymyositis with myoglobinuria in pregnancy: a report and review of the literature. J Rheumatol. 1988;15:513–4.PubMedGoogle Scholar
  55. 55.
    Steiger RM, Boyd EL, Powers DR, Nageotte MP, Towers CV. Acute maternal renal insufficiency in premature labor treated with indomethacin. Am J Perinatol. 1993;10(5):381–3.PubMedCrossRefGoogle Scholar
  56. 56.
    Sanchez de la Nieta MD, Rivera F, de la Torre M, Alcazar R, Caparros G, Paz Alcaide M, Vozmediano C, Sanchez A. Acute renal failure and oligohydramnios induced by magnesium dypirone (metamizol) in a pregnant woman. Nephrol Dial Transplant. 2003;8(8):1679–80.CrossRefGoogle Scholar
  57. 57.
    Moake J. Thrombotic thrombocytopenia purpura and other thrombotic microangiopathies. Best Pract Res Clin Haematol. 2009;22:567–76.PubMedCrossRefGoogle Scholar
  58. 58.
    Stella CL, Dacus J, Guzman E, Dhillon P, Coppage K, How H, Sibai B. The diagnositic dilemma of thrombotic thrombocytopenic prupura/hemolytic uremic syndrome in obstetric triage and emergency department: lessons from 4 tertiary hospitals. Am J Obstet Gynecol. 2009;200:381. e1–e6.PubMedCrossRefGoogle Scholar
  59. 59.
    Sibai B. Imitators of severe pre-eclampsia. Semin Perinatol. 2009;33:196–205.PubMedCrossRefGoogle Scholar
  60. 60.
    Martin JN, Bailey AP, Rehberg JF, Owens MT, Keiser SD, May W. Thrombotic thrombocytopenic purpura in 166 pregnancies: 1955–2006. Am J Obstet Gynecol. 2008;199(2):98–104.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • A. Eric Anderson
    • 1
  • Sophia M. Rothberger Lannon
    • 2
  1. 1.Outpatient, General Nephrology Clinic, Department of MedicineUniversity of Washington Medical CenterSeattleUSA
  2. 2.Department of Obstetrics & GynecologyUniversity of WashingtonSeattleUSA

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