Pregnancy-related Acute Kidney Injury: A Narrative Review of Epidemiology, Pathophysiology, and Clinical Management

Pregnancy-related acute kidney injury (Pr-AKI) is a severe complication of obstetric medicine that remains a significant cause of maternal and fetal morbidity and mortality. Although the burden has declined in many low- and middle-income countries (LMICs) following improvements in prenatal and obstetric care, its incidence has risen in high-income nations, due to older maternal age, the growing prevalence of diabetes and chronic hypertension, as well to more sensitive definition criteria and improved diagnostic tools. Physiological changes during pregnancy can lower the baseline serum creatinine level and may delay diagnosis.This review summarizes current evidence on the epidemiology, pathophysiology, etiologic mechanisms, diagnostic difficulties, management, and outcomes of Pr-AKI. Globally, the condition demonstrates a paradox, i.e., decreasing incidence but persistent mortality in LMICs and increasing incidence in developed countries. Hypertensive disorders of pregnancy, particularly preeclampsia, eclampsia, and the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, have become the predominant causes worldwide. Distinct trimester-specific patterns, overlap with thrombotic microangiopathies and acute fatty liver of pregnancy, and the need to balance maternal and fetal health make Pr-AKI uniquely complex.Improving Pr-AKI outcomes requires early recognition, pregnancyspecific diagnostic biomarkers, and coordinated multidisciplinary care. Strengthening antenatal surveillance, expanding access to renal replacement therapy in resource-limited settings, and providing structured postpartum follow-up are essential to reducing the global burden of Pr-AKI.Pregnancy-related acute kidney injury (Pr-AKI) is a severe complication of obstetric medicine that remains a significant cause of maternal and fetal morbidity and mortality. Although the burden has declined in many low- and middle-income countries (LMICs) following improvements in prenatal and obstetric care, its incidence has risen in high-income nations, due to older maternal age, the growing prevalence of diabetes and chronic hypertension, as well to more sensitive definition criteria and improved diagnostic tools. Physiological changes during pregnancy can lower the baseline serum creatinine level and may delay diagnosis.This review summarizes current evidence on the epidemiology, pathophysiology, etiologic mechanisms, diagnostic difficulties, management, and outcomes of Pr-AKI. Globally, the condition demonstrates a paradox, i.e., decreasing incidence but persistent mortality in LMICs and increasing incidence in developed countries. Hypertensive disorders of pregnancy, particularly preeclampsia, eclampsia, and the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, have become the predominant causes worldwide. Distinct trimester-specific patterns, overlap with thrombotic microangiopathies and acute fatty liver of pregnancy, and the need to balance maternal and fetal health make Pr-AKI uniquely complex.Improving Pr-AKI outcomes requires early recognition, pregnancyspecific diagnostic biomarkers, and coordinated multidisciplinary care. Strengthening antenatal surveillance, expanding access to renal replacement therapy in resource-limited settings, and providing structured postpartum follow-up are essential to reducing the global burden of Pr-AKI.

کلیدواژه ها:

acute kidney injury ، hypertensive ، preeclampsia ، HELLP syndrome ، maternal and fetal outcome ، renal replacement therapy ، pregnancy