Renal Disease in Pregnancy

Brown, Mark; Mangos, George; Peek, Michael; Plaat, F.

doi:10.1002/9781444323016.ch7

Cited by 6 publications

(2 citation statements)

References 109 publications

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“…The second step is administration of intravenous fluids to restore or maintain renal perfusion. [ 112 113 ] This procedure also prevents hypovolemia and ensures an adequate uteroplacental perfusion and fetal well-being. These general measures are followed by pharmacological therapy of AKI and its known complications such as hypertension, hyperkalemia, metabolic acidosis, and anemia.…”

Section: Treatment Of Acute Kidney Injury In Pregnancymentioning

confidence: 99%

Acute kidney injury in pregnancy-specific disorders

Prakash

Ganiger

2017

Indian J Nephrol

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The incidence of acute kidney injury in pregnancy (P-AKI) has declined significantly over the last three decades in developing countries. However, it is still associated with significant fetomaternal mortality and morbidity. The diagnosis of P-AKI is based on the serum creatinine increase. The usual formulas for estimating glomerular filtration rate (GFR) are not validated in this population. The incidence of P-AKI with respect to total AKI cases has decreased in the last three decades from 25% in 1980s to 9% in 2000s at our centre. During the first trimester of gestation, AKI develops most often due to septic abortion or hyperemesis gravidarum. Septic abortion related AKI with respect to total AKI decreased from 9% to 5% in our study. Prevention of unwanted pregnancy and avoidance of septic abortion are keys to eliminate abortion associated AKI in early pregnancy. However, we have not seen AKI on account of hyperemesis gravidarum over a period of 33 years at our center. In the third trimester, the differential diagnosis of AKI in association with pregnancy specific conditions namely preeclampsia/HELLP syndrome, acute fatty liver of pregnancy and thrombotic microangiopathies of pregnancy (P-TMA) is more challenging, because these 3 conditions share several clinical features of thrombotic microangiopathy which makes the diagnosis very difficult on clinical grounds. It is imperative to distinguish these conditions to make appropriate therapeutic decisions. Typically, AFLP and HELLP syndrome improve after delivery of the fetus, whereas plasma exchange is the first-line treatment for pregnancy associated thrombotic microangioathies (P-TMA). We observed that preclampsia/eclampsia is the most common cause of AKI in late third trimester and postpartum periods followed by puerperal sepsis and postpartum hemorrhage. Pregnancy-associated thrombotic microangiopathies (aHUS/TTP) and AFLP are rare causes of AKI during pregnancy in developing countries.

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Section: Treatment Of Acute Kidney Injury In Pregnancymentioning

confidence: 99%

Acute kidney injury in pregnancy-specific disorders

Prakash

Ganiger

2017

Indian J Nephrol

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“…We present a pragmatic review on specific issues and challenges of nephrotic syndrome in pregnancy (not due to preeclampsia), including the common presentation and consequences of nephrotic manifestations in pregnancy. For more information on specific renal diseases in pregnancy, 2,3 especially de novo renal disease, we strongly encourage the reader to seek complete information and advice from local experts and literature. As there are few evidence-based medicine-derived data to guide clinical practice for nephrotic syndrome in pregnancy, this review is based on older descriptive literature, reported case series, experts' opinions, and our own clinical experience and discussions.…”

Section: Introductionmentioning

confidence: 99%

The management challenges of non-preeclampsia-related nephrotic syndrome in pregnancy

Côté

Sauvé

2011

Obstet Med

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Summary: Nephrotic syndrome in a pregnant woman may be challenging, especially when the onset is early in pregnancy or with severe manifestations. Preeclampsia is the most common cause of nephrotic syndrome in pregnancy; however, this review will focus on the management of other renal causes. The aim of this pragmatic review is to address clinical issues that clinicians looking after women with nephrotic syndrome may encounter during pregnancy and the postpartum period. First, we discuss some general issues regarding nephrotic syndrome and its impact on maternal and fetal outcomes in pregnancy, and then we review the maternal management of nephrotic syndrome in pregnancy and during the postpartum period.

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