Why kidneys fail post-partum: a tubulocentric viewpoint

  • Patricia Villie
  • Marc Dommergues
  • Isabelle Brocheriou
  • Giorgina Barbara Piccoli
  • Jérôme Tourret
  • Alexandre Hertig
Review
  • 27 Downloads
Part of the following topical collections:
  1. Obstetric Nephrology

Abstract

Kidneys may fail post-partum in a number of circumstances due, for example, to post-partum haemorrhage, preeclampsia, amniotic fluid embolism or septic abortion. All these conditions in pregnancy and post partum represent a threat not only to the endothelium but also to the renal tubular epithelium, and as such may lead to rapid and also irreversible impairment of the renal function. This paper is a non-systematic review of the literature and of our experience, in which we discuss the main open issues on kidney disease in pregnancy and following delivery, in particular as regards tubular damage, with the aim to help reasoning on acute kidney injury (AKI) following delivery. The review will emphasize the often under-estimated importance of the tubular epithelium in the peri-partum period and will: (1) describe the main characteristics of the renal tissues around delivery; (2) define pregnancy-related AKI according to recent Kidney Disease/Improving Global Outcome (KDIGO) guidelines; (3) discuss the most common circumstances of post-partum AKI; and (4) describe the input expected from urinalysis, renal imaging and kidney biopsy.

Keywords

Acute kidney injury Acute tubular necrosis Pregnancy Preeclampsia Post-partum haemorrhage sFlt-1 PlGF 

Abbreviations

AKI

Acute kidney injury

ATN

Acute tubular necrosis

RBP

Retinol-binding protein

sEng

Soluble endoglin

s-Flt1

Soluble fms-like tyrosine kinase 1

TMA

Thrombotic microangiopathy

VEGF

Vascular endothelial growth factor

Notes

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

References

  1. 1.
    Maynard SE, Min J-Y, Merchan J, Lim K-H, Li J, Mondal S et al (2003) Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest 111(5):649–658CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Venkatesha S, Toporsian M, Lam C, Hanai J, Mammoto T, Kim YM et al (2006) Soluble endoglin contributes to the pathogenesis of preeclampsia. Nat Med 12(6):642–649CrossRefPubMedGoogle Scholar
  3. 3.
    Eremina V, Jefferson JA, Kowalewska J, Hochster H, Haas M, Weisstuch J et al (2008) VEGF inhibition and renal thrombotic microangiopathy. N Engl J Med 358(11):1129–1136CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Eremina V, Sood M, Haigh J, Nagy A, Lajoie G, Ferrara N et al (2003) Glomerular-specific alterations of VEGF-A expression lead to distinct congenital and acquired renal diseases. J Clin Invest 111(5):707–716CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Levine RJ, Maynard SE, Qian C, Lim K-H, England LJ, Yu KF et al (2004) Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 350(7):672–683CrossRefPubMedGoogle Scholar
  6. 6.
    Taylor AA, Davison JM (1997) Albumin excretion in normal pregnancy. Am J Obstet Gynecol 177(6):1559–1560PubMedGoogle Scholar
  7. 7.
    Yoshimatsu J, Matsumoto H, Goto K, Shimano M, Narahara H, Miyakawa I (2006) Relationship between urinary albumin and serum soluble fms-like tyrosine kinase 1 (sFlt-1) in normal pregnancy. Eur J Obstet Gynecol Reprod Biol 128(1–2):204–208CrossRefPubMedGoogle Scholar
  8. 8.
    Strevens H, Wide-Swensson D, Hansen A, Horn T, Ingemarsson I, Larsen S et al (2003) Glomerular endotheliosis in normal pregnancy and pre-eclampsia. BJOG Int J Obstet Gynaecol 110(9):831–836CrossRefGoogle Scholar
  9. 9.
    Aukland K, Krog J (1960) Renal oxygen tension. Nature 188:671CrossRefPubMedGoogle Scholar
  10. 10.
    Sheikh IA, Shaheen FA (1998) Acute renal failure and HELLP syndrome: a single center’s experience. Saudi J Kidney Dis Transpl Off Publ Saudi Cent Organ Transplant Saudi Arab 9(3):290–293Google Scholar
  11. 11.
    Abraham KA, Kennelly M, Dorman AM, Walshe JJ (2003) Pathogenesis of acute renal failure associated with the HELLP syndrome: a case report and review of the literature. Eur J Obstet Gynecol Reprod Biol 108(1):99–102CrossRefPubMedGoogle Scholar
  12. 12.
    Sibai BM, Villar MA, Mabie BC (1990) Acute renal failure in hypertensive disorders of pregnancy. Pregnancy outcome and remote prognosis in thirty-one consecutive cases. Am J Obstet Gynecol 162(3):777–783CrossRefPubMedGoogle Scholar
  13. 13.
    Nelimarkka O, Halkola L, Niinikoski J (1982) Distribution of renal cortical and Medullary tissue oxygenation in hemorrhagic shock. Acta Chir Scand 148(3):213–219PubMedGoogle Scholar
  14. 14.
    Ibarra-Hernández M, Orozco-Guillén OA, de la Alcantar-Vallín ML, Garrido-Roldan R, Jiménez-Alvarado MP, Castro KB et al (2017) Acute kidney injury in pregnancy and the role of underlying CKD: a point of view from México. J Nephrol 30(6):773–780CrossRefPubMedGoogle Scholar
  15. 15.
    Fakhouri F, Deltombe C (2017) Pregnancy-related acute kidney injury in high income countries: still a critical issue. J Nephrol 30(6):767–771CrossRefPubMedGoogle Scholar
  16. 16.
    Abstract (2012) Kidney Int Suppl 2(1):6CrossRefGoogle Scholar
  17. 17.
    Odutayo A, Hladunewich M (2012) Obstetric nephrology: renal hemodynamic and metabolic physiology in normal pregnancy. Clin J Am Soc Nephrol CJASN 7(12):2073–2080CrossRefPubMedGoogle Scholar
  18. 18.
    Hladunewich MA, Lafayette RA, Derby GC, Blouch KL, Bialek JW, Druzin ML et al (2004) The dynamics of glomerular filtration in the puerperium. Am J Physiol Renal Physiol 286(3):F496-503CrossRefPubMedGoogle Scholar
  19. 19.
    Pritchard JA, Cunningham FG, Pritchard SA (1984) The Parkland Memorial Hospital protocol for treatment of eclampsia: evaluation of 245 cases. Am J Obstet Gynecol 148(7):951–963CrossRefPubMedGoogle Scholar
  20. 20.
    Frimat M, Decambron M, Lebas C, Moktefi A, Lemaitre L, Gnemmi V et al (2016) Renal cortical necrosis in postpartum hemorrhage: a case series. Am J Kidney Dis Off J Natl Kidney FoundGoogle Scholar
  21. 21.
    Wong TC (1962) A study on the generalized Shwartzman reaction in pregnant rats induced by bacterial endotoxin. Am J Obstet Gynecol 84:786–797CrossRefPubMedGoogle Scholar
  22. 22.
    Apitz K (1934) Die Wirkung bakterieller kulturfiltrate nach umstimmung des gesamten endothels beim kanichen. Virchows Arch 1–33Google Scholar
  23. 23.
    WOMAN Trial Collaborators (2017) Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet Lond Engl 389(10084):2105–2116CrossRefGoogle Scholar
  24. 24.
    Jeong JY, Kim SH, Sim JS, Lee HJ, Do K-H, Moon MH et al (2002) MR findings of renal cortical necrosis. J Comput Assist Tomogr 26(2):232–236CrossRefPubMedGoogle Scholar
  25. 25.
    François M, Tostivint I, Mercadal L, Bellin MF, Izzedine H, Deray G (2000) MR imaging features of acute bilateral renal cortical necrosis. Am J Kidney Dis Off J Natl Kidney Found 35(4):745–748CrossRefGoogle Scholar
  26. 26.
    McKay H, Ducharlet K, Temple F, Sutherland T (2014) Contrast enhanced ultrasound (CEUS) in the diagnosis of post-partum bilateral renal cortical necrosis: a case report and review of the literature. Abdom Imaging 39(3):550–553CrossRefPubMedGoogle Scholar
  27. 27.
    Assali NS, Kaplan SA, Fomon SJ, Douglass RA (1953) Renal function studies in toxemia of pregnancy; excretion of solutes and renal hemodynamics during osmotic diuresis in hydropenia. J Clin Invest 32(1):44–51CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Lafayette RA, Druzin M, Sibley R, Derby G, Malik T, Huie P et al (1998) Nature of glomerular dysfunction in pre-eclampsia. Kidney Int 54(4):1240–1249CrossRefPubMedGoogle Scholar
  29. 29.
    Prakash J, Ganiger VC, Prakash S, Iqbal M, Kar DP, Singh U et al (2018) Acute kidney injury in pregnancy with special reference to pregnancy-specific disorders: a hospital based study (2014–2016). J Nephrol 31(1):79–85CrossRefPubMedGoogle Scholar
  30. 30.
    Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M et al (2016) Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. N Engl J Med 374(1):13–22CrossRefPubMedGoogle Scholar
  31. 31.
    American College of Obstetricians and Gynecologists (2013) Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 122(5):1122–1131CrossRefGoogle Scholar
  32. 32.
    Piccoli GB, Cabiddu G, Castellino S, Gernone G, Santoro D, Moroni G et al (2017) A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy. J Nephrol 30(3):307–317CrossRefPubMedGoogle Scholar
  33. 33.
    Xiao J, Niu J, Ye X, Yu Q, Gu Y (2013) Combined biomarkers evaluation for diagnosing kidney injury in preeclampsia. Hypertens Pregnancy 32(4):439–449CrossRefPubMedGoogle Scholar
  34. 34.
    Sass N, Facca TA, Pereira ARPR., Famá EA, Nishida SK, Moreira SR et al (2012) PP019 The role of renal markers in women with and without preeclampsia: evaluation of urinary excretion of podocytes and proteins. Pregnancy Hypertens 2(3):251–252CrossRefPubMedGoogle Scholar
  35. 35.
    Codsi E, Garovic VD, Gonzalez-Suarez ML, Milic N, Borowski KS, Rose CH et al (2017) Longitudinal characterization of renal proximal tubular markers in normotensive and preeclamptic pregnancies. Am J Physiol Regul Integr Comp Physiol 312(5):R773–R778CrossRefPubMedGoogle Scholar
  36. 36.
    George JN, Nester CM (2014) Syndromes of thrombotic microangiopathy. N Engl J Med 371(7):654–666CrossRefPubMedGoogle Scholar
  37. 37.
    Fakhouri F, Roumenina L, Provot F, Sallée M, Caillard S, Couzi L et al (2010) Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations. J Am Soc Nephrol JASN 21(5):859–867CrossRefPubMedGoogle Scholar
  38. 38.
    Hecht JL, Ordi J, Carrilho C, Ismail MR, Zsengeller ZK, Karumanchi SA et al (2017) The pathology of eclampsia: an autopsy series. Hypertens Pregnancy 5:1–10CrossRefGoogle Scholar
  39. 39.
    Fakhouri F, Jablonski M, Lepercq J, Blouin J, Benachi A, Hourmant M et al (2008) Factor H, membrane cofactor protein, and factor I mutations in patients with hemolysis, elevated liver enzymes, and low platelet count syndrome. Blood 112(12):4542–4545CrossRefPubMedGoogle Scholar
  40. 40.
    Crovetto F, Borsa N, Acaia B, Nishimura C, Frees K, Smith RJH et al (2012) The genetics of the alternative pathway of complement in the pathogenesis of HELLP syndrome. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet 25(11):2322–2325Google Scholar
  41. 41.
    Fisher KA, Luger A, Spargo BH, Lindheimer MD (1981) Hypertension in pregnancy: clinical-pathological correlations and remote prognosis. Medicine (Baltimore) 60(4):267–276CrossRefGoogle Scholar
  42. 42.
    Slater DN, Hague WM (1984) Renal morphological changes in idiopathic acute fatty liver of pregnancy. Histopathology 8(4):567–581CrossRefPubMedGoogle Scholar
  43. 43.
    Kang HM, Ahn SH, Choi P, Ko Y-A, Han SH, Chinga F et al (2015) Defective fatty acid oxidation in renal tubular epithelial cells has a key role in kidney fibrosis development. Nat Med 21(1):37–46CrossRefPubMedGoogle Scholar
  44. 44.
    Liban E, Raz S (1969) A clinicopathologic study of fourteen cases of amniotic fluid embolism. Am J Clin Pathol 51(4):477–486CrossRefPubMedGoogle Scholar
  45. 45.
    Pritchard JA, Whalley PJ (1971) Abortion complicated by Clostridium perfringens infection. Am J Obstet Gynecol 111(4):484–492CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Nephrology 2018

Authors and Affiliations

  1. 1.APHP, Hôpital TenonUrgences Néphrologiques et Transplantation RénaleParisFrance
  2. 2.Department of Gynecology and ObstetricsAPHP, Groupe Hospitalier La Pitié Salpêtrière Charles FoixParisFrance
  3. 3.Department of PathologyAPHP, Hôpital TenonParisFrance
  4. 4.Sorbonne Universités, UPMC Université Paris 06, UMR_S 1155ParisFrance
  5. 5.Centre Hospitalier du Mans Le MansLe MansFrance
  6. 6.Department of Clinical and Biological SciencesUniversity of TorinoTurinItaly

Personalised recommendations