Treatment Approaches for Acute Kidney Injury During Pregnancy

Acute kidney injury (AKI) during pregnancy is a rare but serious medical condition that requires prompt diagnosis and targeted intervention. While modern prenatal care has significantly reduced maternal complications, AKI remains a critical concern due to its potential impact on both mother and fetus. Understanding the underlying causes and appropriate management strategies is essential for optimal outcomes.

Common Causes of Pregnancy-Related Acute Kidney Injury

Several pregnancy-specific conditions are frequently associated with acute renal failure in expectant mothers. Among the most prevalent are pregnancy-induced hypertension (PIH), acute fatty liver of pregnancy (AFLP), and HELLP syndrome—a life-threatening disorder characterized by hemolysis, elevated liver enzymes, and low platelet count. These conditions can lead to systemic inflammation, endothelial damage, and impaired kidney perfusion, ultimately resulting in organ dysfunction.

Other Contributing Factors

In addition to these primary obstetric disorders, other factors may contribute to renal compromise. Severe and prolonged vomiting or diarrhea can cause significant fluid loss, leading to prerenal azotemia—a form of AKI caused by reduced blood flow to the kidneys. In such cases, volume depletion is the main culprit, and early rehydration often reverses the condition before permanent damage occurs.

Rarely, mechanical obstruction may play a role. The expanding uterus during late pregnancy can compress one or both ureters, especially in women with anatomical predispositions, potentially causing obstructive nephropathy. Although uncommon, this should be considered in cases where urinary output remains low despite adequate fluid resuscitation.

Management Based on Etiology

Effective treatment hinges on identifying the root cause of kidney injury. When AKI stems from dehydration due to gastrointestinal losses, simple interventions like intravenous fluid replacement are typically sufficient. Restoring circulating volume usually leads to a rapid increase in urine output and normalization of creatinine levels within hours to days.

Severe Obstetric Conditions Requiring Aggressive Intervention

However, when AKI is driven by preeclampsia, HELLP syndrome, or acute fatty liver, the situation becomes far more critical. These conditions often progress rapidly and pose severe risks to both maternal and fetal health. In many cases, delivery of the baby becomes the definitive treatment, as removal of the placenta halts the pathological process.

Depending on the severity of renal impairment, additional supportive therapies may be necessary. Renal replacement therapy (RRT), including dialysis, might be required if there is persistent oliguria, electrolyte imbalances, fluid overload, or uremic symptoms. Timely initiation of RRT can be life-saving and allows for stabilization while preparing for delivery.

Importance of Multidisciplinary Care

Managing acute kidney injury in pregnancy demands a coordinated approach involving obstetricians, nephrologists, intensivists, and neonatologists. Early recognition, accurate diagnosis, and swift action are key to preventing long-term complications. With advances in critical care and monitoring technologies, survival rates have improved significantly—even in complex cases.

Pregnant women experiencing symptoms such as decreased urination, swelling, persistent nausea, or high blood pressure should seek immediate medical evaluation. Proactive screening and timely intervention remain the best defense against adverse outcomes related to acute renal failure during pregnancy.