Pregnancy-Related Acute Kidney Injury Management

Pregnancy-related acute kidney injury (PR-AKI) represents a sudden decline in renal function during gestation or the puerperium, precipitated by conditions such as pre-eclampsia, haemorrhage, sepsis and thrombotic microangiopathy. Physiological adaptations in pregnancy—most notably renal hyperfiltration and plasma volume expansion—mask early renal impairment, making timely diagnosis challenging. Management centres on early recognition through adjusted biomarkers, careful fluid and blood pressure control, and prompt correction of underlying causes. In severe cases, renal replacement therapy may be required, while multidisciplinary teams coordinate maternal and foetal monitoring. Long-term follow-up is advised, as PR-AKI may predispose women to chronic kidney disease and cardiovascular complications. Globally, access to antenatal care and rapid obstetric interventions are critical to reducing maternal and perinatal morbidity and mortality, particularly in low-resource settings.

Research from Nature Portfolio

Recent studies have yielded a novel gestational-age-adjusted equation for estimating glomerular filtration rate in pregnant women, accounting for dynamic changes in serum creatinine throughout gestation. By modelling serum creatinine distributions across weeks of pregnancy, reference intervals for each gestational stage were established, facilitating detection of inadequate hyperfiltration and early renal dysfunction. This approach offers clinicians a continuous and smooth tool to distinguish physiological adaptations from pathological decline, thereby improving the monitoring and management of at-risk pregnancies.

Pregnancy-Related Acute Kidney Injury Management publication trend

The graph below shows the total number of articles in pregnancy-related acute kidney injury management across all publications each year (not limited to Nature Index journals).

Technical terms

Acute kidney injury (AKI): An abrupt reduction in kidney function, often measured by serum creatinine rise or decreased urine output.

Estimated glomerular filtration rate (eGFR): A calculation of kidney filtration capacity, adjusted for factors such as age, sex and body size, here modified for pregnancy.

Hyperfiltration: Increased glomerular filtration rate above normal, common in early pregnancy as physiological adaptation.

Pre-eclampsia: A hypertensive disorder of pregnancy characterised by new-onset hypertension and organ dysfunction, often involving the kidneys.

HELLP syndrome: A severe variant of pre-eclampsia defined by Haemolysis, Elevated Liver enzymes and Low Platelet count.

References

1. Development of a formula for estimated glomerular filtration rate in pregnant women from physiological hyperfiltration of serum creatinine. Scientific Reports (2024).
2. Prediction Model for Pre-Eclampsia Using Gestational-Age-Specific Serum Creatinine Distribution. Biology (2023).
3. Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases. Journal of Clinical Medicine (2018).
4. Incidence of acute kidney injury during pregnancy and its prognostic value for adverse clinical outcomes: A systematic review and meta-analysis. Medicine (2022).