title: Acute kidney injury in pregnancy: a clinical challenge.
abstract: The incidence of acute kidney injury in pregnancy declined significantly over the second half of the 20th century; however, it is still associated with major maternal and perinatal morbidity and mortality. A set of systemic and renal physiological adaptive mechanisms occur during a normal gestation that will constrain several changes in laboratory parameters of renal function, electrolytes, fluid and acid-base balances. The diagnosis of acute kidney injury in pregnancy is based on the serum creatinine increase. The usual formulas for estimating glomerular filtration rate are not validated in this population. During the first trimester of gestation, acute kidney injury develops most often due to hyperemesis gravidarum or septic abortion. In the third trimester, the differential diagnosis is more challenging for the obstetrician and the nephrologist and comprises some pathologies that are reviewed in this article: preeclampsia/HELLP syndrome, acute fatty liver of pregnancy and thrombotic microangiopathies.
authors.affiliation: Nephrology Department, Coimbra's University Hospitals, Coimbra, Portugal. susana_machado_@hotmail.com
authors.forename: Susana
authors.initials: S
authors.lastname: Machado
authors.forename: Nuno
authors.initials: N
authors.lastname: Figueiredo
authors.forename: Andreia
authors.initials: A
authors.lastname: Borges
authors.forename: Maria
authors.initials: M
authors.lastname: São José Pais
authors.forename: Luís
authors.initials: L
authors.lastname: Freitas
authors.forename: Paulo
authors.initials: P
authors.lastname: Moura
authors.forename: Mário
authors.initials: M
authors.lastname: Campos
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D005234:Fatty Liver / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy; D057049:Thrombotic Microangiopathies / Q000150:complications / Q000175:diagnosis / Q000628:therapy