Pregnancy-associated acute kidney injury — consensus report of the 32nd Acute Disease Quality Initiative workgroup

Acute kidney injury (AKI) during pregnancy and the postpartum period, known as pregnancy-associated AKI (PrAKI), is an important health concern and driver of health inequity worldwide. Causes of PrAKI include sepsis, autoimmune disorders and pregnancy-specific pathologies such as hypertensive disorders. Common risk factors include maternal comorbidities and use of nephrotoxic medications. PrAKI accounts for a substantial proportion of maternal mortality and morbidity, particularly in low-income and middle-income countries, and may also adversely affect the fetus, resulting in death, premature birth and small for gestational age. In this Consensus Statement, we present recommendations on the causes, diagnosis, management and follow-up of PrAKI from the 32nd Acute Disease Quality Initiative meeting, which involved international experts in obstetrics, midwifery, obstetric medicine, paediatrics, internal medicine, anaesthesiology, nephrology and critical care. We suggest that pregnant and postpartum women at a high risk of PrAKI should be identified to enable prevention, surveillance and timely diagnosis. The multidisciplinary management of these patients should be tailored to treat their specific causes of PrAKI to optimize short-term and long-term neonatal and maternal outcomes. Further observational and interventional studies are needed to address existing gaps in knowledge of PrAKI and improve maternal and fetal outcomes.