Insuffisance rénale aiguë et grossesse

Abstract

Acute renal failure (ARF) in pregnancy includes all causes of acute impairment of renal function, from the beginning of pregnancy to delivery. The threshold-level of plasma creatinin that indicates ARF in the pregnant woman is lowered to 80 μmol l^–1 due to the physiological increase of the glomerular flow during normal pregnancy. In clinical practice, specific pregnancy ARFs follow a bi-modal distribution: ARFs of the 1^st trimester include those ARFs associated to septic abortions and gravidic emesia. 3^rd trimester ARFs include essentially those renal complications related to severe pre-eclampsia and, more exceptionally, to acute gravidic steatosis. The other causes of ARFs remain more rare. In countries where abortion is legal and where pregnancies are bound to strict follow-up, the incidence of this dangerous obstetrical complication has considerably regressed (from 1/ 3,000 births to less than 1/ 20,000). This incidence remains highly variable from a country to another, and differs according to the local legislation. The vital prognosis, both for the foetus and the mother, is related to the earliness of the diagnosis, and the rapidity of treatment initiation. The management of such patients at the 3^rd trimester of pregnancy should be undertaken in a sanitary environment fully equipped with follow-up and treatment means, both for the mother and the foetus, and combining competences in obstetrics, paediatrics, nephrology, and intensive care as well. Gestational ARF is to be suspected in any case of increased creatinin level (>80 μmol l^–1) and/ or oliguria since the blood creatinin level is normally lowered during pregnancy.