Acute Kidney Damage in Pregnancy Etiopathogenesis, Diagnostics and Basic Principles of Treatment

摘要

Acute kidney damage associated with pregnancy occurs in1/20.000 pregnancies. In developing countries, the main cause ofthe development of acute kidney damage is septic abortion, andpreeclampsia in the developed countries of the world. Preeclamp-sia is defined as newly developed hypertension, proteinuria andswelling in pregnant women after the 20th week of gestation. Itoccurs due to disorders in the development of placenta and sys-temic disorders of the function of the endothelium of the mother.It is treated with methyldopa, magnesium sulfate and timely deliv-ery. Urgent delivery is indicated if the age of gestation is ≥ 34weeks. HELLP syndrome is a difficult form of preeclampsia. Itsmain characteristics are decreased platelet count, microangio-pathic hemolysis anemia, increased concentration of aminotrans-ferase in the serum and acute kidney damage. Severe HELLP syn-drome is treated with emergency delivery, antihypertensives,magnesium sulfate, and in some cases plasmapheresis and hemo-dialysis. Acute fatty liver in pregnancy occurs because of de-creased activity of the LCHAD enzyme of the fetus. Due to the re-duced beta oxidation of fatty acids in the hepatocytes of the fetus,long chain fatty acids that cause damage to the mother's hepato-cytes are released. Swansea criteria are used for diagnosis, andthe difficult form of the disease is treated with plasmapheresis andextracorporeal liver support. Atypical HUS is due to a reducedprotein activity that regulates the activity of the alternative path-way of the complement system. Its main features are thrombocy-topenia, microangiopathic hemolytic anemia and acute kidneydamage. It is treated with plasmapheresis, and in case of re-sistance with eculizumab. Thrombotic thrombocytopenic purpurais due to decreased activity of the ADAMTS13 enzyme. It is char-acterized by thrombocytopenia, microangiopathic hemolytic ane-mia, high temperature, nervous system disorders and acute kidneydamage. It is treated with plasmapheresis, and severe form of dis-ease with corticosteroids and azathioprine. Early detection andtimely treatment of acute kidney damage provides a good outcomefor the mother and fetus.