妊娠期急性肾损伤的处理策略

Processing strategy of acute kidney injury in pregnancy

急性肾损伤(AKI)是妊娠期的急性并发症,一旦发生母婴死亡率较高,应引起足够的重视。妊娠期肾脏会发生一系列生理性变化以适应母婴需求,如肾脏体积增大、肾小球滤过率(GFR)增加、高凝状态等,使肾脏较非妊娠者更易受损。常见的妊娠期AKI主要有妊娠期相关血栓性微血管病[TMA,如子痫前期(PE);溶血、肝酶升高、血小板减少(HELLP)综合征;血栓性血小板减少性紫癜(TTP);溶血尿毒综合征(HUS)];妊娠期急性脂肪肝(AFLP);急性肾小管坏死(ATN)及急性肾皮质坏死(ARCN)等。对于重度PE、HELLP综合征和AFLP,一经诊断,应终止妊娠,而TTP及HUS应以血浆置换为主要治疗措施。对于ATN及ARCN导致的妊娠期AKI,应给予祛除病因及支持对症治疗,有指征时可行血液净化疗法。

Acute kidney injury is an acute complication in pregnancy with a high mortality of the maternal and infant once occurs,which should arouse enough attention.There are a series of physiological changes of kidneys in pregnancy to adapt to demands from the maternal and infant,such as kidney volume increase,glomerular filtration rate （GFR）increase,and hypercoagulable state,etc.Therefore,the kidneys in pregnancy were more easily subject to injury than kidneys not in pregnancy.The common causes of acute kidney injury in pregnancy includes pregnancy-related thrombotic microangiopathy [TMA,such as pre-eclampsia （PE ）;hemolysis, elevated liver enzymes, low platelets （HELLP ） syndrome;thrombotic thrombocytopenic purpura （TTP）;and hemolytic uremic syndrome （HUS）];acute fatty liver in pregnancy （AFLP）;acute tubular necrosis （ATN）,and acute renal cortical necrosis （ARCN）,etc.For severe PE, HELLP syndrome,and AFLP,the pregnancy should be terminated upon diagnosis.while for TTP,and HUS,plasmapheresis should be the main treatment method.For acute kidney injury resulting from ATN or ARCN in pregnancy,both etiological treatment and symptomatic treatment should be given,with blood purification therapy being administered when indicated.