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流产相关的急性肾损伤:一例病例报告

Miscarriage-Related Acute Kidney Injury: A Case Report.

作者信息

Kojima Junya, Ono Masanori, Tasaki Koichiro, Nagai Takeshi, Nagao Toshitaka, Rinno Sho, Kanno Yoshihiko, Yoshida Rie, Suzuki Tomoo, Kuji Naoaki, Nishi Hirotaka

机构信息

Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan.

Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan.

出版信息

Int Med Case Rep J. 2024 Apr 6;17:295-300. doi: 10.2147/IMCRJ.S451790. eCollection 2024.

Abstract

BACKGROUND

Pregnancy-related acute kidney injury (Pr-AKI) is associated with significant maternal and fetal morbidity and mortality, with a three- to four-fold increase in perinatal mortality. Pr-AKI can arise from various obstetric complications, such as hyperemesis gravidarum, septic abortion, hypertensive disorders of pregnancy, pyelonephritis, and antiphospholipid antibody syndrome. Therefore, early diagnosis and appropriate intervention, including the identification of the underlying etiology, are important to effectively manage Pr-AKI. Therefore, we report a case of Pr-AKI after early miscarriage in a patient without hyperemesis gravidarum or septic abortion whose renal function gradually improved postoperatively for miscarriage.

CASE PRESENTATION

A 34-year-old primigravid woman was referred to us for perinatal management at 6 weeks of gestation. Unfortunately, she was diagnosed with miscarriage 1 week later. The patient had no history of hyperemesis gravidarum or septic abortion; however, she developed oliguria, and her serum creatinine and blood urea nitrogen levels were abnormally increased. Consequently, she underwent a renal biopsy to evaluate renal dysfunction, which indicated tubulointerstitial damage. The patient also underwent manual vacuum aspiration for a miscarriage. Postoperatively, her urine output increased, and her renal function improved. She was determined to have experienced Pr-AKI due to her miscarriage.

CONCLUSION

Our patient had Pr-AKI after a miscarriage in the absence of other causes. This case report highlights the presence of unknown causes of Pr-AKI, warranting further research for the development of preventive interventions.

摘要

背景

妊娠相关急性肾损伤(Pr-AKI)与孕产妇和胎儿的严重发病和死亡相关,围产期死亡率增加三到四倍。Pr-AKI可由各种产科并发症引起,如妊娠剧吐、感染性流产、妊娠高血压疾病、肾盂肾炎和抗磷脂抗体综合征。因此,早期诊断和适当干预,包括确定潜在病因,对于有效管理Pr-AKI很重要。因此,我们报告一例早期流产后发生Pr-AKI的病例,该患者无妊娠剧吐或感染性流产,流产术后肾功能逐渐改善。

病例介绍

一名34岁初产妇在妊娠6周时转诊至我院进行围产期管理。不幸的是,1周后她被诊断为流产。该患者无妊娠剧吐或感染性流产病史;然而,她出现少尿,血清肌酐和血尿素氮水平异常升高。因此,她接受了肾活检以评估肾功能不全,结果显示为肾小管间质损伤。该患者还接受了人工负压吸引术以终止妊娠。术后,她的尿量增加,肾功能改善。由于流产,她被确定为发生了Pr-AKI。

结论

我们的患者在流产后发生了Pr-AKI,且无其他病因。本病例报告突出了Pr-AKI存在未知病因,有必要进一步研究以开发预防性干预措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2e6/11005928/3e300ade457d/IMCRJ-17-295-g0001.jpg

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