Acute kidney injury in pregnancy

Abstract

Pregnancy-related acute kidney injury (P-AKI) incidence has reduced over the recent years with better accessibility and advances in health care. It is still a concern in developing countries where septic abortions and puerperal sepsis persist due to lack of health facilities. Recent advances have helped in a better understanding of pathogenesis of disorders like pre-eclampsia, acute fatty liver of pregnancy, and thrombotic microangiopathy which has helped the physicians to solve the enigma in both diagnosis and management of these conditions. Diagnosis of P-AKI is challenging due to normal maternal physiological changes. Usual definitions of AKI are not very accurate in pregnancy and newer markers for diagnosis of AKI are not well studied in pregnancy. Early identification of the cause of P-AKI and its prompt treatment holds the key in the management of P-AKI. It is of utmost importance to maintain the hemodynamics and acid base balance for ensuring proper utero-placental blood flow and fetal well being in P-AKI. There is neither particular modality of RRT which is better than other nor a preset dialysis prescription for P-AKI, and renal replacement therapy should be individualized to provide optimal care.