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Acute Kidney Injury in Pregnancy: The Changing Landscape for the 21st Century
Pregnancy-related acute kidney injury (Pr-AKI) remains a large public health problem, with decreasing incidences in developing countries but seemingly increasing incidences in the United States and Canada. These epidemiologic changes are reflective of the advances in medical and obstetric care, as w...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932309/ https://www.ncbi.nlm.nih.gov/pubmed/29725629 http://dx.doi.org/10.1016/j.ekir.2018.01.011 |
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author | Rao, Swati Jim, Belinda |
author_facet | Rao, Swati Jim, Belinda |
author_sort | Rao, Swati |
collection | PubMed |
description | Pregnancy-related acute kidney injury (Pr-AKI) remains a large public health problem, with decreasing incidences in developing countries but seemingly increasing incidences in the United States and Canada. These epidemiologic changes are reflective of the advances in medical and obstetric care, as well as changes in underlying maternal risk factors. The risk factors associated with advanced maternal age, such as hypertension, diabetes, chronic kidney disease, and those associated with reproductive technologies such as multiple gestations, are increasing. Traditional causes of Pr-AKI, such as septic abortions and puerperal sepsis, have been replaced by hypertensive diseases, such as preeclampsia and thrombotic microangiopathies comprising thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS). In this review, we discuss the global impact of Pr-AKI on maternal and fetal outcomes, the predominant etiologies, and key clinical features to distinguish diagnoses, such as preeclampsia/hemolysis elevated liver function test and low platelet (HELLP) syndrome, acute fatty liver disease of pregnancy (AFLP), and other thrombotic microangiopathies. New insights into the pathogenesis of preeclampsia, TTP/aHUS, and AFLP that have unearthed possible therapeutic targets are summarized. We also delve into special consideration needed to give to pyelonephritis and postobstructive causes of Pr-AKI. With each diagnosis, we offer the latest treatment recommendations, such as the positive reports from the use of eculizumab to treat aHUS. In the end, we hope to arm the clinician with the best tools to understand and address this morbid problem that does not seem to be disappearing. |
format | Online Article Text |
id | pubmed-5932309 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-59323092018-05-03 Acute Kidney Injury in Pregnancy: The Changing Landscape for the 21st Century Rao, Swati Jim, Belinda Kidney Int Rep Review Pregnancy-related acute kidney injury (Pr-AKI) remains a large public health problem, with decreasing incidences in developing countries but seemingly increasing incidences in the United States and Canada. These epidemiologic changes are reflective of the advances in medical and obstetric care, as well as changes in underlying maternal risk factors. The risk factors associated with advanced maternal age, such as hypertension, diabetes, chronic kidney disease, and those associated with reproductive technologies such as multiple gestations, are increasing. Traditional causes of Pr-AKI, such as septic abortions and puerperal sepsis, have been replaced by hypertensive diseases, such as preeclampsia and thrombotic microangiopathies comprising thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS). In this review, we discuss the global impact of Pr-AKI on maternal and fetal outcomes, the predominant etiologies, and key clinical features to distinguish diagnoses, such as preeclampsia/hemolysis elevated liver function test and low platelet (HELLP) syndrome, acute fatty liver disease of pregnancy (AFLP), and other thrombotic microangiopathies. New insights into the pathogenesis of preeclampsia, TTP/aHUS, and AFLP that have unearthed possible therapeutic targets are summarized. We also delve into special consideration needed to give to pyelonephritis and postobstructive causes of Pr-AKI. With each diagnosis, we offer the latest treatment recommendations, such as the positive reports from the use of eculizumab to treat aHUS. In the end, we hope to arm the clinician with the best tools to understand and address this morbid problem that does not seem to be disappearing. Elsevier 2018-02-02 /pmc/articles/PMC5932309/ /pubmed/29725629 http://dx.doi.org/10.1016/j.ekir.2018.01.011 Text en © 2018 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Review Rao, Swati Jim, Belinda Acute Kidney Injury in Pregnancy: The Changing Landscape for the 21st Century |
title | Acute Kidney Injury in Pregnancy: The Changing Landscape for the 21st Century |
title_full | Acute Kidney Injury in Pregnancy: The Changing Landscape for the 21st Century |
title_fullStr | Acute Kidney Injury in Pregnancy: The Changing Landscape for the 21st Century |
title_full_unstemmed | Acute Kidney Injury in Pregnancy: The Changing Landscape for the 21st Century |
title_short | Acute Kidney Injury in Pregnancy: The Changing Landscape for the 21st Century |
title_sort | acute kidney injury in pregnancy: the changing landscape for the 21st century |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932309/ https://www.ncbi.nlm.nih.gov/pubmed/29725629 http://dx.doi.org/10.1016/j.ekir.2018.01.011 |
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