Acute kidney injury requiring dialysis in pregnancy and postpartum: Case series and literature review.

INTRODUCTION

The occurrence of acute kidney injury (AKI) during pregnancy is a rare event but is associated with higher maternal-fetal morbidity and mortality, particularly when dialysis is required.

METHODS

This is a retrospective observational study from a single center to evaluate pregnant women with AKI undergoing hemodialysis and followed by the nephrology team in charge of in-hospital patient visits at UNIFESP-EPM between 2005 and 2019.

RESULTS

The characteristics of 10 pregnant women who required hemodialysis during the study period were analyzed, with a mean age of 31.4 years, and the majority were primiparous (57.1 %). The etiologies of AKI were preeclampsia (50 %) or sepsis (50 %). All patients in the AKI group underwent hemodialysis in the postpartum period. The mortality rate was 40 %, and all other pregnant women were discharged without the need for dialysis. The live birth rate was 60 %, with 66.7 % of premature births.

CONCLUSIONS

Pregnant women with AKI requiring dialysis presented renal dysfunction in the postpartum period due to obstetric complications or infectious conditions. In our sample, there was a high mortality rate of 40 %. However, all surviving pregnant women showed at least partial recovery of renal function and were discharged without the need for dialysis. Fetal outcomes included a lower rate of live births and a higher rate of prematurity compared to the general population.