Acute Kidney Injury in Pregnancy.
Acute Kidney Injury in Pregnancy.
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DOI：
10.1016/j.semnephrol.2017.05.010
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发表时间：
2017-07
影响因子：
3.3
通讯作者：
Garovic VD
中科院分区：
文献类型：
--
作者：
Jim B;Garovic VD
妊娠相关急性肾损伤(AKI)的发病率在过去30年中有所下降，但它仍然是孕产妇和胎儿发病率和死亡率的重要原因。与妊娠相关的AKI原因，如先兆子痫、妊娠急性脂肪肝、HELLP综合征和血栓性微血管病变(血栓性血小板减少性紫癜、非典型溶血性尿毒症综合征)表现出重叠的特征，通常是一个诊断难题。仅根据临床标准可能很难或不可能区分这些情况。在疑难和罕见的病例中，可能需要考虑进行肾活检以获得准确的诊断并促进适当的治疗，但需要仔细权衡风险和好处。在早期病例报告中，使用eculizumab治疗非典型HUS已证明有效。与妊娠无关的原因，如容量耗竭和肾盂肾炎，需要及早采取积极的复苏和抗生素措施。在这篇综述中，我们将讨论妊娠AKI的各种病因，目前的诊断方法，以及最新的治疗策略。鉴于最近怀孕时产妇年龄增加的趋势，以及现代生殖方法的可获得性，这两种方法都可能与重大共病有关，围绕怀孕AKI的问题可能在未来几年变得更加相关。
Pregnancy-related acute kidney injury (AKI) has declined in incidence in the last three decades, although it remains an important cause of maternal and fetal morbidity and mortality. Pregnancy-related causes of AKI such as preeclampsia, acute fatty liver of pregnancy, HELLP syndrome, and the thrombotic microangiopathies (thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome) exhibit overlapping features and often present a diagnostic conundrum. Differentiating among these conditions may be difficult or impossible based on clinical criteria only. In difficult and rare cases, a renal biopsy may need to be considered for the exact diagnosis and facilitate appropriate treatment, but the risks and benefits will need to be carefully weighed. The use of eculizumab for the treatment of atypical HUS has demonstrated efficacy in early case reports. Non-pregnancy related causes such as volume depletion and pyelonephritis require early and aggressive resuscitative and antibiotic measures. We will discuss in this review the various etiologies of AKI in pregnancy, current diagnostic approaches, and the latest treatment strategies. Given the recent trends of increasing maternal age at the time of pregnancy, as well the availability of modern reproductive methods both of which may be associated with significant co-morbidities, the issues surrounding AKI in pregnancy may become more relevant in the coming years.
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影响因子：
2.4
作者：
Glaser, Alexander P.;Schaeffer, Anthony J.
通讯作者：
Schaeffer, Anthony J.
影响因子：
2.8
作者：
Hallstensen, Randi Fykse;Bergseth, Grethe;Mollnes, Tom Eirik
通讯作者：
Mollnes, Tom Eirik
影响因子：
2.6
作者：
Gurrieri, Carmelina;Garovic, Vesna D.;Weingarten, Toby N.
通讯作者：
Weingarten, Toby N.
影响因子：
7.2
作者：
Hill, JB;Sheffield, JS;Wendel, GD
通讯作者：
Wendel, GD
影响因子：
6.1
作者：
Day, Clara;Hewins, Peter;Lipkin, Graham
通讯作者：
Lipkin, Graham