Acute Kidney Injury during pregnancy

Abstract

In intensive care units, taking care of pregnant women developing acute kidney injury [AKI] pre- or immediately post-partum implies to know the high susceptibility of maternal endothelium. The latter is induced by the presence of a placenta which physiologically produces large amounts of anti-angiogenic factors such as sFlt-1. The main mechanism of AKI is acute tubular necrosis, most probably of ischemic nature. However, when AKI develops contemporarily of a HELLP syndrome (Hemolysis Enzyme Liver Low Platelets),  i.e. of a thrombotic microangiopathy, the differential diagnostic procedure may be highly complex : other causes, exceptional, but calling for more specific therapies than delivery, must indeed be contemplated by the intensivist. In such circumstances, uncover the effect of time alone is key.