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Pr-AKI: Acute Kidney Injury in Pregnancy – Etiology, Diagnostic Workup, Management

Despite significant improvements in inpatient and outpatient management, pregnancy-related acute kidney injury (Pr-AKI) remains an important risk factor for early and late maternal and fetal morbidity and mortality. There is a discrepancy between the incidence of Pr-AKI in developing and in develope...

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Autores principales: Scurt, Florian G., Morgenroth, Ronnie, Bose, Katrin, Mertens, Peter R., Chatzikyrkou, Christos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2022
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8893985/
https://www.ncbi.nlm.nih.gov/pubmed/35250379
http://dx.doi.org/10.1055/a-1666-0483
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author Scurt, Florian G.
Morgenroth, Ronnie
Bose, Katrin
Mertens, Peter R.
Chatzikyrkou, Christos
author_facet Scurt, Florian G.
Morgenroth, Ronnie
Bose, Katrin
Mertens, Peter R.
Chatzikyrkou, Christos
author_sort Scurt, Florian G.
collection PubMed
description Despite significant improvements in inpatient and outpatient management, pregnancy-related acute kidney injury (Pr-AKI) remains an important risk factor for early and late maternal and fetal morbidity and mortality. There is a discrepancy between the incidence of Pr-AKI in developing and in developed countries, with the former experiencing a decrease and the latter an increase in Pr-AKI in recent decades. Whereas septic and hemorrhagic complications predominated in the past, nowadays hypertensive disorders and thrombotic microangiopathy are the leading causes of Pr-AKI. Modern lifestyles and the availability and widespread use of in-vitro fertilization techniques in industrialized countries have allowed more women of advanced age to become pregnant. This has led to a rise in the percentage of high-risk pregnancies due to the disorders and comorbidities inherent to or accompanying aging, such as diabetes, arterial hypertension and preexisting chronic kidney disease. Last but not least, the heterogeneity of symptoms, the often overlapping clinical and laboratory characteristics and the pathophysiological changes related to pregnancy make the diagnosis and management of Pr-AKI a difficult and challenging task for the treating physician. In addition to general supportive management strategies such as volume substitution, blood pressure control, prevention of seizures or immediate delivery, each disease entity requires a specific therapy to reduce maternal and fetal complications. In this review, we used the current literature to provide a summary of the physiologic and pathophysiologic changes in renal physiology which occur during pregnancy. In the second part, we present common and rare disorders which lead to Pr-AKI and provide an overview of the available treatment options.
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spelling pubmed-88939852022-03-04 Pr-AKI: Acute Kidney Injury in Pregnancy – Etiology, Diagnostic Workup, Management Scurt, Florian G. Morgenroth, Ronnie Bose, Katrin Mertens, Peter R. Chatzikyrkou, Christos Geburtshilfe Frauenheilkd Despite significant improvements in inpatient and outpatient management, pregnancy-related acute kidney injury (Pr-AKI) remains an important risk factor for early and late maternal and fetal morbidity and mortality. There is a discrepancy between the incidence of Pr-AKI in developing and in developed countries, with the former experiencing a decrease and the latter an increase in Pr-AKI in recent decades. Whereas septic and hemorrhagic complications predominated in the past, nowadays hypertensive disorders and thrombotic microangiopathy are the leading causes of Pr-AKI. Modern lifestyles and the availability and widespread use of in-vitro fertilization techniques in industrialized countries have allowed more women of advanced age to become pregnant. This has led to a rise in the percentage of high-risk pregnancies due to the disorders and comorbidities inherent to or accompanying aging, such as diabetes, arterial hypertension and preexisting chronic kidney disease. Last but not least, the heterogeneity of symptoms, the often overlapping clinical and laboratory characteristics and the pathophysiological changes related to pregnancy make the diagnosis and management of Pr-AKI a difficult and challenging task for the treating physician. In addition to general supportive management strategies such as volume substitution, blood pressure control, prevention of seizures or immediate delivery, each disease entity requires a specific therapy to reduce maternal and fetal complications. In this review, we used the current literature to provide a summary of the physiologic and pathophysiologic changes in renal physiology which occur during pregnancy. In the second part, we present common and rare disorders which lead to Pr-AKI and provide an overview of the available treatment options. Georg Thieme Verlag KG 2022-03-03 /pmc/articles/PMC8893985/ /pubmed/35250379 http://dx.doi.org/10.1055/a-1666-0483 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Scurt, Florian G.
Morgenroth, Ronnie
Bose, Katrin
Mertens, Peter R.
Chatzikyrkou, Christos
Pr-AKI: Acute Kidney Injury in Pregnancy – Etiology, Diagnostic Workup, Management
title Pr-AKI: Acute Kidney Injury in Pregnancy – Etiology, Diagnostic Workup, Management
title_full Pr-AKI: Acute Kidney Injury in Pregnancy – Etiology, Diagnostic Workup, Management
title_fullStr Pr-AKI: Acute Kidney Injury in Pregnancy – Etiology, Diagnostic Workup, Management
title_full_unstemmed Pr-AKI: Acute Kidney Injury in Pregnancy – Etiology, Diagnostic Workup, Management
title_short Pr-AKI: Acute Kidney Injury in Pregnancy – Etiology, Diagnostic Workup, Management
title_sort pr-aki: acute kidney injury in pregnancy – etiology, diagnostic workup, management
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8893985/
https://www.ncbi.nlm.nih.gov/pubmed/35250379
http://dx.doi.org/10.1055/a-1666-0483
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