Acute kidney injury in late pregnancy with microangiopathic hemolysis and thrombocytopenia: Characteristics by etiology

Etiology	Usual onset	Typical severity of acute kidney injury	Elevated liver enzymes	Clinical manifestations of acute liver failure*	Spontaneous recovery or improvement after delivery	Other characteristics
Preeclampsia with severe features/HELLP	Third trimester^¶	Variable	Common	Uncommon	Yes	More likely to occur in the first pregnancy
TTP	Second and third trimesters	Mild^Δ	Uncommon	Rare	No	Severely reduced ADAMTS13 activity
CM-TMA	Late third trimester or immediately postpartum	Severe	Uncommon	Rare	No	Less likely to occur in the first pregnancy
AFLP	Third trimester	Variable^◊	Always	Common	Yes	Often accompanied by loss of appetite, nausea, vomiting, and abdominal pain

HELLP: hemolysis, elevated liver enzymes, and low platelets; TTP: thrombotic thrombocytopenic purpura; CM-TMA: complement-mediated thrombotic microangiopathy; AFLP: acute fatty liver of pregnancy; ADAMTS13: A Disintegrin And Metalloprotease with a ThromboSpondin type 1 motif, member 13; AKI: acute kidney injury.

* Manifestations of acute liver failure in AFLP may include jaundice, ascites, encephalopathy, hypoglycemia, and disseminated intravascular coagulation.

¶ Preeclampsia does not occur before 20 weeks gestation in nonmolar pregnancies, except occasionally in the presence of hypercoagulable inflammatory disorders, such as the antiphospholipid antibody syndrome.

Δ Severe AKI requiring dialysis occurs in <5% of patients.

◊ AFLP is associated with AKI in up to 60% of cases.

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خرید پکیج

Acute kidney injury in late pregnancy with microangiopathic hemolysis and thrombocytopenia: Characteristics by etiology