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Published on: July 17, 2016
Acute Kidney Injury in Pregnancies Complicated With Preeclampsia or HELLP Syndrome
Jamie Szczepanski1, Ashley Griffin2, Sarah Novotny1
1Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, United States.
Insights
Pregnancy-related acute kidney injury (PR-AKI) is a growing obstetric concern. Standardized diagnostic criteria and better animal models are needed to understand and manage PR-AKI and its long-term effects.
Area of Science:
- Obstetrics and Gynecology
- Nephrology
- Maternal-Fetal Medicine
Background:
- Pregnancy-related acute kidney injury (PR-AKI) is a severe obstetric complication with substantial maternal and fetal risks.
- The incidence of PR-AKI is rising, but accurate assessment is hindered by the absence of validated, pregnancy-specific diagnostic criteria.
- Hypertensive disorders and thrombotic microangiopathies of pregnancy are key drivers of PR-AKI.
Purpose of the Study:
- To highlight the increasing incidence and significant risks associated with PR-AKI.
- To underscore the need for a validated, pregnancy-specific definition and classification system for PR-AKI.
- To emphasize the requirement for refined animal models to study PR-AKI mechanisms and consequences.
Main Methods:
- Review of current data on PR-AKI incidence and contributing factors.
- Discussion of the limitations in diagnosing and classifying PR-AKI in pregnancy.
- Exploration of potential long-term sequelae of PR-AKI.
Main Results:
- PR-AKI is an increasing obstetric complication with significant morbidity and mortality.
- Lack of uniform, validated diagnostic criteria impedes accurate incidence calculation.
- Hypertensive and thrombotic microangiopathic disorders are major contributors to PR-AKI.
Conclusions:
- PR-AKI may lead to persistent renal, cardiovascular, and neurocognitive issues post-partum.
- Development of pregnancy-specific diagnostic criteria is crucial for advancing PR-AKI research.
- Improved animal models are essential for elucidating PR-AKI pathogenesis and sequelae.
Abstract:
Acute kidney injury that occurs during pregnancy or in the post-partum period (PR-AKI) is a serious obstetric complication with risk of significant associated maternal and fetal morbidity and mortality. Recent data indicates that the incidence of PR-AKI is increasing, although accurate calculation is limited by the lack of a uniform diagnostic criteria that is validated in pregnancy. Hypertensive and thrombotic microangiopathic disorders of pregnancy have been identified as major contributors to the burden of PR-AKI. As is now accepted regarding preeclampsia, HELLP syndrome and atypical hemolytic uremic syndrome, it is believed that PR-AKI may have long-term renal, cardiovascular and neurocognitive consequences that persist beyond the post-partum period. Further research regarding PR-AKI could be advanced by the development of a pregnancy-specific validated definition and classification system; and the establishment of refined animal models that would allow researchers to further elucidate the mechanisms and sequelae of the disorder.
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