Management of Acute Kidney Injury in Pregnancy for the Obstetrician

Determinar la frecuencia, la evolución clínica, el tratamiento y el desenlace de la lesión renal aguda (LRA) en pacientes embarazadas con preeclampsia severa (PS) menores de 20 años de edad.

Estudio observacional, transversal, retrospectivo y analítico en una serie de 23 pacientes embarazadas menores de 20 años de edad con PS atendidas en la UCI de un hospital de alta especialidad de la ciudad de México durante los años 2018 y 2019. Se consultaron los expedientes para conocer la frecuencia de enfermas que desarrollaron LRA (creatinina sérica ≥ 1,1 mg/dl), complicaciones, diuresis, tratamiento con fármacos, terapia de reemplazo, desenlace (recuperación, hemodiálisis) y mortalidad. Los resultados se compararon con los de enfermas de la serie que no presentaron LRA. Se utilizó estadística descriptiva, prueba U de Mann Whitney y prueba exacta de Fisher con el programa SPSS versión 20.

Veintidós enfermas tenían riñones nativos y una portaba injerto renal. La frecuencia de pacientes con LRA fue del 43,47% (n = 10) con media de la creatinina sérica de 1,59 ± 0,63 mg/dl (límites 1,1 a 3,2) y diuresis de 0,91 ± 0,74 ml/kg/h. Las 23 enfermas recibieron furosemida como fármaco individual intravenoso (60,87%; n = 14) o posterior a la infusión de solución NaCl 0,9% (39,13%; n = 9). La LRA se recuperó en el 39,13% (n = 9) y se precisó hemodiálisis en la paciente trasplantada (4,34%), con muerte materna del 0%.

La frecuencia de LRA fue elevada, con un solo caso que requirió hemodiálisis, sin mortalidad materna. El uso irrestricto de furosemida en todos los casos resultó relevante.

To determine the frequency, clinical course, treatment and outcome of acute kidney injury (AKI) in pregnant patients under 20 years of age with severe preeclampsia (SP).

Observational, cross-sectional, retrospective and analytical study in a series of 23 pregnant patients under 20 years of age with SP attended in the Intensive Care Unit (ICU) of a high specialty hospital in Mexico City during the years 2018 and 2019. Records were consulted to determine the frequency of patients that developed AKI (serum creatinine ≥ 1.1 mg/dL), complications, diuresis, drug treatment, replacement therapy, outcome (recovery, haemodialysis), and mortality. The results were compared with those of the patients in the series that did not present with an AKI. Descriptive statistics, Mann Whitney U test and Fisher's exact test, using SPSS version 20, were used.

Twenty-two patients had native kidneys and one had a kidney graft. The frequency of patients with AKI was 43.47% (n = 10) with mean serum creatinine 1.59 ± 0.63 mg/dL (range 1.1 to 3.2) and urine volume 0.91 ± 0.74 ml/kg/hour. All 23 patients received furosemide, as an individual drug intravenously 60.87% (n = 14), and 39.13% (n = 9) after the infusion of 0.9% NaCl solution. AKI recovered in 39.13% (n = 9), and haemodialysis was performed in the transplanted patient (4.34%), with 0% maternal death.

The frequency of AKI was high with only one case requiring haemodialysis, and no maternal mortality. The unrestricted use of furosemide in all cases was relevant.

Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly.

Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants.

In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.