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

Florian G. Scurt; Ronnie Morgenroth; Katrin Bose; Peter R. Mertens; Christos Chatzikyrkou

doi:10.1055/a-1666-0483

Geburtshilfe und Frauenheilkunde, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2022; 82(03): 297-316
DOI: 10.1055/a-1666-0483

GebFra Science

Review/Übersicht

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

Artikel in mehreren Sprachen: English | deutsch

Autor*innen

Florian G. Scurt

¹Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Germany
Ronnie Morgenroth

¹Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Germany
Katrin Bose

²Universitätsklinik für Gastroenterologie, Hepatologie und Infektiologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Germany
Peter R. Mertens

¹Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Germany
Christos Chatzikyrkou

³PHV-Dialysezentrum, Halberstadt, Germany

⁴Klinik für Nephrologie, Medizinische Hochschule Hannover, Hannover, Germany

Abstract

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.

Key words

pregnancy - acute kidney injury - AKI - Pr-AKI - pathophysiology - cause - diagnosis - management

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Referenzen

References/Literatur
1 Liu Y, Ma X, Zheng J. et al. Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2017; 17: 235
2 Hildebrand AM, Liu K, Shariff SZ. et al. Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period. J Am Soc Nephrol 2015; 26: 3085-3091
3 Lin HY, Lai JI, Lai YC. et al. Acute renal failure in severe pancreatitis: A population-based study. Ups J Med Sci 2011; 116: 155-159
4 Devani K, Charilaou P, Radadiya D. et al. Acute pancreatitis: Trends in outcomes and the role of acute kidney injury in mortality- A propensity-matched analysis. Pancreatology 2018; 18: 870-877
5 Mehrabadi A, Dahhou M, Joseph KS. et al. Investigation of a Rise in Obstetric Acute Renal Failure in the United States, 1999–2011. Obstet Gynecol 2016; 127: 899-906
6 Lockitch G. Clinical biochemistry of pregnancy. Crit Rev Clin Lab Sci 1997; 34: 67-139
7 Jeyabalan A, Novak J, Danielson LA. et al. Essential role for vascular gelatinase activity in relaxin-induced renal vasodilation, hyperfiltration, and reduced myogenic reactivity of small arteries. Circ Res 2003; 93: 1249-1257
8 Conrad KP. Emerging role of relaxin in the maternal adaptations to normal pregnancy: implications for preeclampsia. Semin Nephrol 2011; 31: 15-32
9 Soma-Pillay P, Nelson-Piercy C, Tolppanen H. et al. Physiological changes in pregnancy. Cardiovasc J Afr 2016; 27: 89-94
10 Cheung KL, Lafayette RA. Renal physiology of pregnancy. Adv Chronic Kidney Dis 2013; 20: 209-214
11 Sims EA, Krantz KE. Serial studies of renal function during pregnancy and the puerperium in normal women. J Clin Invest 1958; 37: 1764-1774
12 De Alvarez RR. Renal glomerulotubular mechanisms during normal pregnancy. I. Glomerular filtration rate, renal plasma flow, and creatinine clearance. Am J Obstet Gynecol 1958; 75: 931-944
13 Dunlop W. Serial changes in renal haemodynamics during normal human pregnancy. Br J Obstet Gynaecol 1981; 88: 1-9
14 Odutayo A, Hladunewich M. Obstetric nephrology: renal hemodynamic and metabolic physiology in normal pregnancy. Clin J Am Soc Nephrol 2012; 7: 2073-2080
15 Roberts M, Lindheimer MD, Davison JM. Altered glomerular permselectivity to neutral dextrans and heteroporous membrane modeling in human pregnancy. Am J Physiol 1996; 270: F338-F343
16 Milne JE, Lindheimer MD, Davison JM. Glomerular heteroporous membrane modeling in third trimester and postpartum before and during amino acid infusion. Am J Physiol Renal Physiol 2002; 282: F170-F175
17 Benjamin N, Rymer J, Todd SD. et al. Sensitivity to angiotensin II of forearm resistance vessels in pregnancy. Br J Clin Pharmacol 1991; 32: 523-525
18 Stennett AK, Qiao X, Falone AE. et al. Increased vascular angiotensin type 2 receptor expression and NOS-mediated mechanisms of vascular relaxation in pregnant rats. Am J Physiol Heart Circ Physiol 2009; 296: H745-H755
19 Sealey JE, McCord D, Taufield PA. et al. Plasma prorenin in first-trimester pregnancy: relationship to changes in human chorionic gonadotropin. Am J Obstet Gynecol 1985; 153: 514-519
20 Weir RJ, Doig A, Fraser R. et al. Studies of the renin-angiotension-aldosterone system, cortisol, DOC, and ADH in normal and hypertensive pregnancy. Perspect Nephrol Hypertens 1976; 5: 251-261
21 Tkachenko O, Shchekochikhin D, Schrier RW. Hormones and hemodynamics in pregnancy. Int J Endocrinol Metab 2014; 12: e14098
22 Beers K, Patel N. Kidney Physiology in Pregnancy. Adv Chronic Kidney Dis 2020; 27: 449-454
23 Lumbers ER, Pringle KG. Roles of the circulating renin-angiotensin-aldosterone system in human pregnancy. Am J Physiol Regul Integr Comp Physiol 2014; 306: R91-R101
24 Davison JM, Gilmore EA, Durr J. et al. Altered osmotic thresholds for vasopressin secretion and thirst in human pregnancy. Am J Physiol 1984; 246: F105-F109
25 Nolten WE, Lindheimer MD, Oparil S. et al. Desoxycorticosterone in normal pregnancy. I. Sequential studies of the secretory patterns of desoxycorticosterone, aldosterone, and cortisol. Am J Obstet Gynecol 1978; 132: 414-420
26 Rodger M, Sheppard D, Gandara E. et al. Haematological problems in obstetrics. Best Pract Res Clin Obstet Gynaecol 2015; 29: 671-684
27 Davison JM, Dunlop W. Renal hemodynamics and tubular function normal human pregnancy. Kidney Int 1980; 18: 152-161
28 Davison JM, Hytten FE. The effect of pregnancy on the renal handling of glucose. Br J Obstet Gynaecol 1975; 82: 374-381
29 Hayashi M, Ueda Y, Hoshimoto K. et al. Changes in urinary excretion of six biochemical parameters in normotensive pregnancy and preeclampsia. Am J Kidney Dis 2002; 39: 392-400
30 Higby K, Suiter CR, Phelps JY. et al. Normal values of urinary albumin and total protein excretion during pregnancy. Am J Obstet Gynecol 1994; 171: 984-989
31 Cietak KA, Newton JR. Serial quantitative maternal nephrosonography in pregnancy. Br J Radiol 1985; 58: 405-413
32 Rasmussen PE, Nielsen FR. Hydronephrosis during pregnancy: a literature survey. Eur J Obstet Gynecol Reprod Biol 1988; 27: 249-259
33 Wadasinghe SU, Metcalf L, Metcalf P. et al. Maternal Physiologic Renal Pelvis Dilatation in Pregnancy: Sonographic Reference Data. J Ultrasound Med 2016; 35: 2659-2664
34 Landau RL, Lugibihl K. Inhibition of the sodium-retaining influence of aldosterone by progesterone. J Clin Endocrinol Metab 1958; 18: 1237-1245
35 Irons DW, Baylis PH, Davison JM. Effect of atrial natriuretic peptide on renal hemodynamics and sodium excretion during human pregnancy. Am J Physiol 1996; 271: F239-F242
36 Kovacs CS, Kronenberg HM. Maternal-fetal calcium and bone metabolism during pregnancy, puerperium, and lactation. Endocr Rev 1997; 18: 832-872
37 Kovacs CS. Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab 2001; 86: 2344-2348
38 Woodrow JP, Sharpe CJ, Fudge NJ. et al. Calcitonin plays a critical role in regulating skeletal mineral metabolism during lactation. Endocrinology 2006; 147: 4010-4021
39 Olausson H, Goldberg GR, Laskey MA. et al. Calcium economy in human pregnancy and lactation. Nutr Res Rev 2012; 25: 40-67
40 Bardicef M, Bardicef O, Sorokin Y. et al. Extracellular and intracellular magnesium depletion in pregnancy and gestational diabetes. Am J Obstet Gynecol 1995; 172: 1009-1013
41 Chen WW, Sese L, Tantakasen P. et al. Pregnancy associated with renal glucosuria. Obstet Gynecol 1976; 47: 37-40
42 Welsh 3rd GW, Sims EA. The mechanisms of renal glucosuria in pregnancy. Diabetes 1960; 9: 363-369
43 Laughon SK, Catov J, Powers RW. et al. First trimester uric acid and adverse pregnancy outcomes. Am J Hypertens 2011; 24: 489-495
44 Boyle JA, Campbell S, Duncan AM. et al. Serum uric acid levels in normal pregnancy with observations on the renal excretion of urate in pregnancy. J Clin Pathol 1966; 19: 501-503
45 Machida H. Influence of progesterone on arterial blood and CSF acid-base balance in women. J Appl Physiol Respir Environ Exerc Physiol 1981; 51: 1433-1436
46 Vijayan M, Avendano M, Chinchilla KA. et al. Acute kidney injury in pregnancy. Curr Opin Crit Care 2019; 25: 580-590
47 Jim B, Garovic VD. Acute Kidney Injury in Pregnancy. Semin Nephrol 2017; 37: 378-385
48 Wiles K, Bramham K, Seed PT. et al. Serum Creatinine in Pregnancy: A Systematic Review. Kidney Int Rep 2019; 4: 408-419
49 Mazzachi BC, Peake MJ, Ehrhardt V. Reference range and method comparison studies for enzymatic and Jaffe creatinine assays in plasma and serum and early morning urine. Clin Lab 2000; 46: 53-55
50 Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med 2008; 358: 929-939
51 Lisnevskaia L, Murphy G, Isenberg D. Systemic lupus erythematosus. Lancet 2014; 384: 1878-1888
52 Dorner T, Furie R. Novel paradigms in systemic lupus erythematosus. Lancet 2019; 393: 2344-2358
53 Schreiber J, Eisenberger U, de Groot K. [Lupus nephritis]. Internist (Berl) 2019; 60: 468-477
54 Tektonidou MG, Dasgupta A, Ward MM. Risk of End-Stage Renal Disease in Patients With Lupus Nephritis, 1971–2015: A Systematic Review and Bayesian Meta-Analysis. Arthritis Rheumatol 2016; 68: 1432-1441
55 Hanly JG, OʼKeeffe AG, Su L. et al. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford) 2016; 55: 252-262
56 Gasparotto M, Gatto M, Binda V. et al. Lupus nephritis: clinical presentations and outcomes in the 21st century. Rheumatology (Oxford) 2020; 59: v39-v51
57 Clowse ME, Magder LS, Witter F. et al. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum 2005; 52: 514-521
58 Rahman FZ, Rahman J, Al-Suleiman SA. et al. Pregnancy outcome in lupus nephropathy. Arch Gynecol Obstet 2005; 271: 222-226
59 Ruiz-Irastorza G, Crowther M, Branch W. et al. Antiphospholipid syndrome. Lancet 2010; 376: 1498-1509
60 Schlembach D. Fetal Growth Restriction – Diagnostic Work-up, Management and Delivery. Geburtshilfe Frauenheilkd 2020; 80: 1016-1025
61 Petri M. The Hopkins Lupus Pregnancy Center: ten key issues in management. Rheum Dis Clin North Am 2007; 33: 227-235 v
62 Kwok LW, Tam LS, Zhu T. et al. Predictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus. Lupus 2011; 20: 829-836
63 Buyon JP, Kim MY, Guerra MM. et al. Kidney Outcomes and Risk Factors for Nephritis (Flare/De Novo) in a Multiethnic Cohort of Pregnant Patients with Lupus. Clin J Am Soc Nephrol 2017; 12: 940-946
64 Lightstone L, Hladunewich MA. Lupus Nephritis and Pregnancy: Concerns and Management. Semin Nephrol 2017; 37: 347-353
65 Anders HJ, Saxena R, Zhao MH. et al. Lupus nephritis. Nat Rev Dis Primers 2020; 6: 7
66 Pasternak Y, Lifshitz D, Shulman Y. et al. Diagnostic accuracy of random urinary protein-to-creatinine ratio for proteinuria in patients with suspected pre-eclampsia. Arch Gynecol Obstet 2021;
67 Fishel Bartal M, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. Am J Obstet Gynecol 2020;
68 Krane NK, Hamrahian M. Pregnancy: kidney diseases and hypertension. Am J Kidney Dis 2007; 49: 336-345
69 Kim MY, Buyon JP, Guerra MM. et al. Angiogenic factor imbalance early in pregnancy predicts adverse outcomes in patients with lupus and antiphospholipid antibodies: results of the PROMISSE study. Am J Obstet Gynecol 2016; 214: 108.e1-108.e14
70 Buyon JP. Updates on lupus and pregnancy. Bull NYU Hosp Jt Dis 2009; 67: 271-275
71 Koh JH, Ko HS, Kwok SK. et al. Hydroxychloroquine and pregnancy on lupus flares in Korean patients with systemic lupus erythematosus. Lupus 2015; 24: 210-217
72 Clowse ME, Magder L, Witter F. et al. Hydroxychloroquine in lupus pregnancy. Arthritis Rheum 2006; 54: 3640-3647
73 Abarientos C, Sperber K, Shapiro DL. et al. Hydroxychloroquine in systemic lupus erythematosus and rheumatoid arthritis and its safety in pregnancy. Expert Opin Drug Saf 2011; 10: 705-714
74 Izmirly PM, Costedoat-Chalumeau N, Pisoni CN. et al. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation 2012; 126: 76-82
75 Gotestam Skorpen C, Hoeltzenbein M, Tincani A. et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016; 75: 795-810
76 Fischer-Betz R, Haase I. [Pregnancy with lupus erythematosus-an update]. Z Rheumatol 2020; 79: 359-366
77 Poon LC, Kametas NA, Maiz N. et al. First-trimester prediction of hypertensive disorders in pregnancy. Hypertension 2009; 53: 812-818
78 Poon LC, Shennan A, Hyett JA. et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet 2019; 145 (Suppl. 01) 1-33
79 Roberge S, Villa P, Nicolaides K. et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther 2012; 31: 141-146
80 Roberge S, Nicolaides K, Demers S. et al. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol 2017; 216: 110-120.e6
81 Berger R, Kyvernitakis I, Maul H. Spontaneous Preterm Birth: Is Prevention with Aspirin Possible?. Geburtshilfe Frauenheilkd 2021; 81: 304-310
82 Rolnik DL, Wright D, Poon LC. et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med 2017; 377: 613-622
83 Fischer-Betz R, Specker C. Pregnancy in systemic lupus erythematosus and antiphospholipid syndrome. Best Pract Res Clin Rheumatol 2017; 31: 397-414
84 Tektonidou MG, Andreoli L, Limper M. et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 2019; 78: 1296-1304
85 Lee EE, Jun JK, Lee EB. Management of Women with Antiphospholipid Antibodies or Antiphospholipid Syndrome during Pregnancy. J Korean Med Sci 2021; 36: e24
86 Abalos E, Cuesta C, Grosso AL. et al. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol 2013; 170: 1-7
87 Leffert LR. Whatʼs new in obstetric anesthesia? Focus on preeclampsia. Int J Obstet Anesth 2015; 24: 264-271
88 Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009; 33: 130-137
89 Powles K, Gandhi S. Postpartum hypertension. CMAJ 2017; 189: E913
90 Rath W, Tsikouras P, Stelzl P. HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge: Common Features and Differences. Geburtshilfe Frauenheilkd 2020; 80: 499-507
91 [Anonym] Hypertension in Pregnancy: The Management of hypertensive Disorders during Pregnancy. London: National Collaborating Centre for Womenʼs and Childrenʼs Health (UK); 2010
92 AWMF. 015/018 – S1-Leitlinie: Diagnostik und Therapie hypertensiver Schwangerschaftserkrankungen. 2021. Stand: 09.02.2017. Accessed June 01, 2021 at: https://www.awmf.org/
93 Bajpai D. Preeclampsia for the Nephrologist: Current Understanding in Diagnosis, Management, and Long-term Outcomes. Adv Chronic Kidney Dis 2020; 27: 540-550
94 Phipps EA, Thadhani R, Benzing T. et al. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol 2019; 15: 275-289
95 [Anonym] Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135: e237-e260
96 Brown MA, Magee LA, Kenny LC. et al. Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension 2018; 72: 24-43
97 Webster K, Fishburn S, Maresh M. et al. Diagnosis and management of hypertension in pregnancy: summary of updated NICE guidance. BMJ 2019; 366: l5119
98 Bello NA, Woolley JJ, Cleary KL. et al. Accuracy of Blood Pressure Measurement Devices in Pregnancy: A Systematic Review of Validation Studies. Hypertension 2018; 71: 326-335
99 Deharde D, Klockenbusch W, Schmitz R. et al. Hydroxychloroquine as a Preventive and Therapeutic Option in Preeclampsia – a Literature Review. Geburtshilfe Frauenheilkd 2020; 80: 679-685
100 Verlohren S. Neue Trends in der Diagnostik und Therapie der Präeklampsie. Frauenheilkunde up2date 2018; 12: 535-546
101 Chappell LC, Cluver CA, Kingdom J. et al. Pre-eclampsia. Lancet 2021; 398: 341-354
102 Schaefer-Graf U, Ensenauer R, Gembruch U. et al. Obesity and Pregnancy. Guideline of the German Society of Gynecology and Obstetrics (S3-Level, AWMF Registry No. 015–081, June 2019). Geburtshilfe Frauenheilkd 2021; 81: 279-303
103 Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol 2009; 113: 1299-1306
104 Machado S, Figueiredo N, Borges A. et al. Acute kidney injury in pregnancy: a clinical challenge. J Nephrol 2012; 25: 19-30
105 Sibai BM, Ramadan MK, Usta I. et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993; 169: 1000-1006
106 Gul A, Aslan H, Cebeci A. et al. Maternal and fetal outcomes in HELLP syndrome complicated with acute renal failure. Ren Fail 2004; 26: 557-562
107 Zeisler H, Hund M, Verlohren S. The sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. N Engl J Med 2016; 374: 1785-1786
108 Thadhani R, Hagmann H, Schaarschmidt W. et al. Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia. J Am Soc Nephrol 2016; 27: 903-913
109 Thadhani R, Kisner T, Hagmann H. et al. Pilot study of extracorporeal removal of soluble fms-like tyrosine kinase 1 in preeclampsia. Circulation 2011; 124: 940-950
110 Matin M, Morgelin M, Stetefeld J. et al. Affinity-Enhanced Multimeric VEGF (Vascular Endothelial Growth Factor) and PlGF (Placental Growth Factor) Variants for Specific Adsorption of sFlt-1 to Restore Angiogenic Balance in Preeclampsia. Hypertension 2020; 76: 1176-1184
111 Lokki AI, Kaartokallio T, Holmberg V. et al. Analysis of Complement C3 Gene Reveals Susceptibility to Severe Preeclampsia. Front Immunol 2017; 8: 589
112 Burwick RM, Feinberg BB. Eculizumab for the treatment of preeclampsia/HELLP syndrome. Placenta 2013; 34: 201-203
113 Vaught AJ, Gavriilaki E, Hueppchen N. et al. Direct evidence of complement activation in HELLP syndrome: A link to atypical hemolytic uremic syndrome. Exp Hematol 2016; 44: 390-398
114 Elabd H, Elkholi M, Steinberg L. et al. Eculizumab, a novel potential treatment for acute kidney injury associated with preeclampsia/HELLP syndrome. BMJ Case Rep 2019; 12: e228709
115 Lu AB, Lazarus B, Rolnik DL. et al. Pregnancy Prolongation After Eculizumab Use in Early-Onset Preeclampsia. Obstet Gynecol 2019; 134: 1215-1218
116 Brocklebank V, Wood KM, Kavanagh D. Thrombotic Microangiopathy and the Kidney. Clin J Am Soc Nephrol 2018; 13: 300-317
117 Dashe JS, Ramin SM, Cunningham FG. The long-term consequences of thrombotic microangiopathy (thrombotic thrombocytopenic purpura and hemolytic uremic syndrome) in pregnancy. Obstet Gynecol 1998; 91: 662-668
118 Hellmann M, Hallek M, Scharrer I. [Thrombotic-thrombocytopenic purpura]. Internist (Berl) 2010; 51: 1136 1138–1144
119 Palma LMP, Sridharan M, Sethi S. Complement in Secondary Thrombotic Microangiopathy. Kidney Int Rep 2021; 6: 11-23
120 George JN, Nester CM, McIntosh JJ. Syndromes of thrombotic microangiopathy associated with pregnancy. Hematology Am Soc Hematol Educ Program 2015; 2015: 644-648
121 Fakhouri F. Pregnancy-related thrombotic microangiopathies: Clues from complement biology. Transfus Apher Sci 2016; 54: 199-202
122 Stella CL, Dacus J, Guzman E. et al. The diagnostic dilemma of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in the obstetric triage and emergency department: lessons from 4 tertiary hospitals. Am J Obstet Gynecol 2009; 200: 381.e1-381.e6
123 Scully M, Thomas M, Underwood M. et al. Thrombotic thrombocytopenic purpura and pregnancy: presentation, management, and subsequent pregnancy outcomes. Blood 2014; 124: 211-219
124 Fakhouri F, Roumenina L, Provot F. et al. Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations. J Am Soc Nephrol 2010; 21: 859-867
125 Bruel A, Kavanagh D, Noris M. et al. Hemolytic Uremic Syndrome in Pregnancy and Postpartum. Clin J Am Soc Nephrol 2017; 12: 1237-1247
126 Noris M, Caprioli J, Bresin E. et al. Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype. Clin J Am Soc Nephrol 2010; 5: 1844-1859
127 Fakhouri F, Hourmant M, Campistol JM. et al. Terminal Complement Inhibitor Eculizumab in Adult Patients With Atypical Hemolytic Uremic Syndrome: A Single-Arm, Open-Label Trial. Am J Kidney Dis 2016; 68: 84-93
128 Servais A, Devillard N, Fremeaux-Bacchi V. et al. Atypical haemolytic uraemic syndrome and pregnancy: outcome with ongoing eculizumab. Nephrol Dial Transplant 2016; 31: 2122-2130
129 Huerta A, Arjona E, Portoles J. et al. A retrospective study of pregnancy-associated atypical hemolytic uremic syndrome. Kidney Int 2018; 93: 450-459
130 Ardissino G, Testa S, Possenti I. et al. Discontinuation of eculizumab maintenance treatment for atypical hemolytic uremic syndrome: a report of 10 cases. Am J Kidney Dis 2014; 64: 633-637
131 Gackler A, Schonermarck U, Dobronravov V. et al. Efficacy and safety of the long-acting C5 inhibitor ravulizumab in patients with atypical hemolytic uremic syndrome triggered by pregnancy: a subgroup analysis. BMC Nephrol 2021; 22: 5
132 Fakhouri F, Vercel C, Fremeaux-Bacchi V. Obstetric nephrology: AKI and thrombotic microangiopathies in pregnancy. Clin J Am Soc Nephrol 2012; 7: 2100-2106
133 Knight M, Nelson-Piercy C, Kurinczuk JJ. et al. A prospective national study of acute fatty liver of pregnancy in the UK. Gut 2008; 57: 951-956
134 Ibdah JA, Bennett MJ, Rinaldo P. et al. A fetal fatty-acid oxidation disorder as a cause of liver disease in pregnant women. N Engl J Med 1999; 340: 1723-1731
135 Vigil-De Gracia P. Acute fatty liver and HELLP syndrome: two distinct pregnancy disorders. Int J Gynaecol Obstet 2001; 73: 215-220
136 Slater DN, Hague WM. Renal morphological changes in idiopathic acute fatty liver of pregnancy. Histopathology 1984; 8: 567-581
137 Nelson DB, Yost NP, Cunningham FG. Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery. Am J Obstet Gynecol 2013; 209: 456.e1-456.e7
138 Chʼng CL, Morgan M, Hainsworth I. et al. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut 2002; 51: 876-880
139 Goel A, Ramakrishna B, Zachariah U. et al. How accurate are the Swansea criteria to diagnose acute fatty liver of pregnancy in predicting hepatic microvesicular steatosis?. Gut 2011; 60: 138-139 author reply 139–140.
140 Sibai BM. Imitators of severe pre-eclampsia. Semin Perinatol 2009; 33: 196-205
141 Tang WX, Huang ZY, Chen ZJ. et al. Combined blood purification for treating acute fatty liver of pregnancy complicated by acute kidney injury: a case series. J Artif Organs 2012; 15: 176-184
142 Liu J, Ghaziani TT, Wolf JL. Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management. Am J Gastroenterol 2017; 112: 838-846
143 Tran TT, Ahn J, Reau NS. ACG Clinical Guideline: Liver Disease and Pregnancy. Am J Gastroenterol 2016; 111: 176-194 quiz 196
144 Burlinson CEG, Sirounis D, Walley KR. et al. Sepsis in pregnancy and the puerperium. Int J Obstet Anesth 2018; 36: 96-107
145 Peerapornratana S, Manrique-Caballero CL, Gomez H. et al. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int 2019; 96: 1083-1099
146 Connolly A, Thorp jr. JM. Urinary tract infections in pregnancy. Urol Clin North Am 1999; 26: 779-787
147 Ovalle A, Levancini M. Urinary tract infections in pregnancy. Curr Opin Urol 2001; 11: 55-59
148 Romero R, Oyarzun E, Mazor M. et al. Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. Obstet Gynecol 1989; 73: 576-582
149 Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2015; (08) CD000490
150 Hooton TM, Scholes D, Stapleton AE. et al. A prospective study of asymptomatic bacteriuria in sexually active young women. N Engl J Med 2000; 343: 992-997
151 Hill JB, Sheffield JS, McIntire DD. et al. Acute pyelonephritis in pregnancy. Obstet Gynecol 2005; 105: 18-23
152 Gilstrap 3rd LC, Cunningham FG, Whalley PJ. Acute pyelonephritis in pregnancy: an anterospective study. Obstet Gynecol 1981; 57: 409-413
153 Rao S, Jim B. Acute Kidney Injury in Pregnancy: The Changing Landscape for the 21st Century. Kidney Int Rep 2018; 3: 247-257
154 Whalley P. Bacteriuria of pregnancy. Am J Obstet Gynecol 1967; 97: 723-738
155 Semler MW, Self WH, Rice TW. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med 2018; 378: 1951
156 Self WH, Semler MW, Wanderer JP. et al. Balanced Crystalloids versus Saline in Noncritically Ill Adults. N Engl J Med 2018; 378: 819-828
157 Yunos NM, Bellomo R, Glassford N. et al. Chloride-liberal vs. chloride-restrictive intravenous fluid administration and acute kidney injury: an extended analysis. Intensive Care Med 2015; 41: 257-264
158 Sharma P, Thapa L. Acute pyelonephritis in pregnancy: a retrospective study. Aust N Z J Obstet Gynaecol 2007; 47: 313-315
159 Zanatta DAL, Rossini MM, Trapani Júnior A. Pyelonephritis in Pregnancy: Clinical and Laboratorial Aspects and Perinatal Results. Rev Bras Ginecol Obstet 2017; 39: 653-658
160 Gait JE. Hemolytic reactions to nitrofurantoin in patients with glucose-6-phosphate dehydrogenase deficiency: theory and practice. DICP 1990; 24: 1210-1213
161 Patterson TF, Andriole VT. Detection, significance, and therapy of bacteriuria in pregnancy. Update in the managed health care era. Infect Dis Clin North Am 1997; 11: 593-608
162 Buddeberg BS, Aveling W. Puerperal sepsis in the 21st century: progress, new challenges and the situation worldwide. Postgrad Med J 2015; 91: 572-578
163 Mackeen AD, Packard RE, Ota E. et al. Antibiotic regimens for postpartum endometritis. Cochrane Database Syst Rev 2015; 2015 (02) CD001067
164 Marchant DJ. Effects of pregnancy and progestational agents on the urinary tract. Am J Obstet Gynecol 1972; 112: 487-501
165 Gorton E, Whitfield HN. Renal calculi in pregnancy. Br J Urol 1997; 80 (Suppl. 01) 4-9
166 Smith CL, Kristensen C, Davis M. et al. An evaluation of the physicochemical risk for renal stone disease during pregnancy. Clin Nephrol 2001; 55: 205-211
167 Maikranz P, Coe FL, Parks JH. et al. Nephrolithiasis and gestation. Baillieres Clin Obstet Gynaecol 1987; 1: 909-919
168 Thomas AA, Thomas AZ, Campbell SC. et al. Urologic emergencies in pregnancy. Urology 2010; 76: 453-460
169 Stothers L, Lee LM. Renal colic in pregnancy. J Urol 1992; 148: 1383-1387
170 Swanson SK, Heilman RL, Eversman WG. Urinary tract stones in pregnancy. Surg Clin North Am 1995; 75: 123-142
171 Srirangam SJ, Hickerton B, Van Cleynenbreugel B. Management of urinary calculi in pregnancy: a review. J Endourol 2008; 22: 867-875
172 Semins MJ, Matlaga BR. Kidney stones during pregnancy. Nat Rev Urol 2014; 11: 163-168
173 Jena M, Mitch WE. Rapidly reversible acute renal failure from ureteral obstruction in pregnancy. Am J Kidney Dis 1996; 28: 457-460
174 Rajasekar D, Hall M. Urinary tract injuries during obstetric intervention. Br J Obstet Gynaecol 1997; 104: 731-734
175 Hara N, Kawaguchi M, Takeda K. et al. Retroperitoneal disorders associated with IgG4-related autoimmune pancreatitis. World J Gastroenterol 2014; 20: 16550-16558
176 Esprit DH, Koratala A, Chornyy V. et al. Obstructive Nephropathy Without Hydronephrosis: Suspicion Is the Key. Urology 2017; 101: e9-e10
177 Bailit JL. Hyperemesis gravidarium: Epidemiologic findings from a large cohort. Am J Obstet Gynecol 2005; 193: 811-814
178 Verberg MF, Gillott DJ, Al-Fardan N. et al. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005; 11: 527-539
179 Kallen B. Hyperemesis during pregnancy and delivery outcome: a registry study. Eur J Obstet Gynecol Reprod Biol 1987; 26: 291-302
180 Goodwin TM. Hyperemesis gravidarum. Clin Obstet Gynecol 1998; 41: 597-605
181 Goodwin TM, Montoro M, Mestman JH. et al. The role of chorionic gonadotropin in transient hyperthyroidism of hyperemesis gravidarum. J Clin Endocrinol Metab 1992; 75: 1333-1337
182 Fell DB, Dodds L, Joseph KS. et al. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol 2006; 107: 277-284
183 Badr KF, Ichikawa I. Prerenal failure: a deleterious shift from renal compensation to decompensation. N Engl J Med 1988; 319: 623-629
184 Sola E, Gines P. Renal and circulatory dysfunction in cirrhosis: current management and future perspectives. J Hepatol 2010; 53: 1135-1145
185 Bonavia A, Vece G, Karamchandani K. Prerenal acute kidney injury-still a relevant term in modern clinical practice?. Nephrol Dial Transplant 2020;
186 Westbrook RH, Dusheiko G, Williamson C. Pregnancy and liver disease. J Hepatol 2016; 64: 933-945
187 Kainer F, Hasbargen U. Emergencies associated with pregnancy and delivery: peripartum hemorrhage. Dtsch Arztebl Int 2008; 105: 629-638
188 Hawkins JL. Obstetric Hemorrhage. Anesthesiol Clin 2020; 38: 839-858
189 Knapp J, Hofer S, Lier H. [Anesthesiological approach to postpartum hemorrhage]. Anaesthesist 2016; 65: 225-240
190 Zagelbaum NK, Bhinder J, Gupta CA. et al. Peripartum Cardiomyopathy Incidence, Risk Factors, Diagnostic Criteria, Pathophysiology, and Treatment Options. Cardiol Rev 2020; 28: 148-155
191 Pearson GD, Veille JC, Rahimtoola S. et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 2000; 283: 1183-1188
192 Demakis JG, Rahimtoola SH, Sutton GC. et al. Natural course of peripartum cardiomyopathy. Circulation 1971; 44: 1053-1061
193 Garg J, Palaniswamy C, Lanier GM. Peripartum cardiomyopathy: definition, incidence, etiopathogenesis, diagnosis, and management. Cardiol Rev 2015; 23: 69-78
194 Scurt FG, Kuczera T, Mertens PR. et al. [The Cardiorenal Syndrome]. Dtsch Med Wochenschr 2019; 144: 910-916
195 Patel AM, Goldfarb S. Got calcium? Welcome to the calcium-alkali syndrome. J Am Soc Nephrol 2010; 21: 1440-1443
196 Kovacs CS. Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery. Physiol Rev 2016; 96: 449-547
197 Khan AA, Clarke B, Rejnmark L. et al. MANAGEMENT OF ENDOCRINE DISEASE: Hypoparathyroidism in pregnancy: review and evidence-based recommendations for management. Eur J Endocrinol 2019; 180: R37-R44
198 Kolnick L, Harris BD, Choma DP. et al. Hypercalcemia in pregnancy: a case of milk-alkali syndrome. J Gen Intern Med 2011; 26: 939-942
199 Fill Malfertheiner S, Malfertheiner MV, Mönkemüller K. et al. Gastroesophageal reflux disease and management in advanced pregnancy: a prospective survey. Digestion 2009; 79: 115-120
200 Ali R, Patel C. Milk-Alkali Syndrome. Treasure Island (FL): StatPearls; 2021