AKI in pregnancy and NSAIDs TOG 2016 Flashcards
PET leads to AKI in what number of cases?
1.5-2%
Most common cause of AKI in pregnancy?
PET
What to consider when giving MgSu in PET
MgSu is really excreted
If UO falls below 20mls/hr or creatinine >90, 50% dose reduction in MgSu should be considered (1g/hr to 0.5g)
Aim serum magnesium 2-3.5
Fluid management for PET
Perinatally 80/ml hr
PP diuresis 36-48hr
Oliguria is common and should not be managed aggressively with fluids even in presence of AKI
How common AKI in HELLP?
3-15%
What is pregnancy associated thrombotic microangiopathy?
1/25000
Thrombi in microvascualture leading to consumptive thrombocytopenia, mechanical haemolytic and end-organ damage.
Clinical phenotypes
- TTP - neurological
- HUS - renal dysfunction
2 main phenotypes of pregnancy associated thrombotic microangiopathy
Clinical phenotypes
- TTP - neurological, ADAMTS 13 abnormality
- HUS - renal dysfunction, complement pathway dysregulation
AKI develop in what % of vases of pregnancy associated TTP
30-80%
When does HUS/TTP most typically present?
HUS Post partum
TTP 2nd/3rd trimester
What proportion of haemolytic uric syndrome progress into end stage renal failure?
76%
How to distinguish between HELLP and HUS/TTP
HUS/TTP profound thrombocytopenia, normal LFT, pre-hepatic hyperbilirubinaemia, no coagulopathy
?ADAMTS 13 deficiency or complement abnormality
How is TTP/HUS managed
Specialist advice
Fresh frozen plasma and or plasma exchange (reduced maternal mortality from 50 to 10%
Eclizumab - atypical HUS ADAMTS13 activity confirmed
How common in kidney injury in acute fatty liver of pregnancy?
AKI common
14% develop renal impairment
3.5% renal replacement
What feature are more suggestive of acute fatty liver of pregnancy vs HELLP?
Low glucose
Raised ammonia
Prodromal vomting
What % of women with lupus in pregnancy will have acute renal failure in pregnancy?
10%
