Acute renal failure and preeclampsia

Abstract

During pregnancy, acute renal failure is mostly represented by preeclampsia (PE) and HELLP (Hemolysis, elevated liver enzymes, low platelets) syndrome. During PE, several angiogenic factors including the vascular endothelial growth factor (VEGF) present failing functions. Recent studies highlighted the role of the soluble fms-like tyrosine kinase-1, a circulating factor that inhibits VEGF binding to its endothelial receptor, leading to placenta ischemia and acute kidney injury.Astrict control of diastolic blood pressure along with early fluid administration must be quickly started to avoid development of renal failure. To date, medical delivery is indicated in complicated PE and represents the only treatment allowing the reversal of the glomerular endothelopathy. Long-term follow-up of PE women highlights that PE is a cardiovascular risk factor as well as a risk of subsequent nephropathy. In that setting, proteinuria during pregnancy or in the peripartum period indicates additional kidney investigations.