Pregnancy-Related Acute Kidney Injury in Spontaneous Ovarian Hyperstimulation Syndrome: A Case Report

Spontaneous ovarian hyperstimulation syndrome (OHSS), a rare entity distinct from iatrogenic forms, presents a diagnostic challenge, particularly in early pregnancy, often leading to delayed recognition and severe systemic complications. We present this case to highlight an unusual and life-threatening presentation of spontaneous OHSS complicated by severe acute kidney injury (AKI) requiring dialysis in early pregnancy, a scenario seldom reported in the literature. A 27-year-old Gravida 2 Para 1 Living 1 (G2P1L1) woman at 10 weeks of spontaneous gestation, with no history of assisted reproductive technology, presented with generalised oedema, reduced urine output, and vaginal bleeding, progressing to multi-organ fluid sequestration, pregnancy loss (missed abortion), and AKI requiring dialysis. Management included aggressive fluid resuscitation, three sessions of hemodialysis for uraemia and severe metabolic acidosis, and therapeutic paracentesis/thoracentesis. Clinicians should maintain a high index of suspicion for OHSS in early gestation with unexplained third spacing and renal dysfunction, and timely fluid management, including renal replacement therapy when indicated.