Jacobi Medical Center, Bronx, NY 10461, USA.
Adv Chronic Kidney Dis. 2013 May;20(3):215-22. doi: 10.1053/j.ackd.2013.02.002.
Pregnancy-related acute kidney injury (PR-AKI) causes significant maternal and fetal morbidity and mortality. Management of PR-AKI warrants a thorough understanding of the physiologic adaptations in the kidney and the urinary tract. Categorization of etiologies of PR-AKI is similar to that of acute kidney injury (AKI) in the nonpregnant population. The causes differ between developed and developing countries, with thrombotic microangiopathies (TMAs) being common in the former and septic abortion and puerperal sepsis in the latter. The incidence of PR-AKI is reported to be on a decline, but there is no consensus on the exact definition of the condition. The physiologic changes in pregnancy make diagnosis of PR-AKI difficult. Newer biomarkers are being studied extensively but are not yet available for clinical use. Early and accurate diagnosis is necessary to improve maternal and fetal outcomes. Timely identification of "at-risk" individuals and treatment of underlying conditions such as sepsis, preeclampsia, and TMAs remain the cornerstone of management. Questions regarding renal replacement therapy such as modality, optimal prescription, and timing of initiation in PR-AKI remain unclear. There is a need to systematically explore these variables to improve care of women with PR-AKI.
妊娠相关性急性肾损伤（PR-AKI）可导致母体和胎儿发病率和死亡率显著增加。PR-AKI 的管理需要深入了解肾脏和泌尿道的生理适应性。PR-AKI 的病因分类与非妊娠人群中的急性肾损伤（AKI）相似。发达国家和发展中国家的病因不同，血栓性微血管病（TMA）在前者中较为常见，而感染性流产和产褥期脓毒症在后者中较为常见。据报道，PR-AKI 的发病率呈下降趋势，但对于该疾病的确切定义尚无共识。妊娠期间的生理变化使得 PR-AKI 的诊断变得困难。新的生物标志物正在广泛研究，但尚未可用于临床应用。早期和准确的诊断对于改善母婴结局至关重要。及时识别“高危”个体并治疗潜在疾病，如脓毒症、子痫前期和 TMA，仍然是管理的基石。关于 PR-AKI 中肾脏替代治疗的问题，如方式、最佳处方和开始时机等，仍不清楚。需要系统地探讨这些变量，以改善 PR-AKI 妇女的护理。
