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{"title":"Physiology of Pregnancy-Related Acute Kidney Injury.","authors":"Desmond Moronge, Jennifer C Sullivan, Jessica L Faulkner","doi":"10.1002/cphy.c220026","DOIUrl":null,"url":null,"abstract":"<p><p>Renal function increases in pregnancy due to the significant hemodynamic demands of plasma volume expansion and the growing feto-placental unit. Therefore, compromised renal function increases the risk for adverse outcomes for pregnant women and their offspring. Acute kidney injury (AKI), or sudden loss of kidney function, is a significant event that requires aggressive clinical management. An AKI event in pregnancy, or in the postpartum period, significantly increases the risk of adverse pregnancy events and fetal and maternal mortality. At present, there are significant clinical challenges to the identification, diagnosis, and management of pregnancy-associated AKI due to changing hemodynamics in pregnancy that alter baseline values and to treatment limitations in pregnancy. Emerging data indicate that patients that are considered clinically recovered following AKI, which is currently assessed primarily by return of plasma creatinine levels to normal, maintain risk of long-term complications indicating that current recovery criteria mask the detection of subclinical renal damage. In association, recent large-scale clinical cohorts indicate that a history of AKI predisposes women to adverse pregnancy events even years after the patient is considered recovered from AKI. Mechanisms via which women develop AKI in pregnancy, or develop adverse pregnancy events post-AKI, are poorly understood and require significant study to better prevent and treat AKI in women. © 2023 American Physiological Society. Compr Physiol 13:4869-4878, 2023.</p>","PeriodicalId":10573,"journal":{"name":"Comprehensive Physiology","volume":"13 3","pages":"4869-4878"},"PeriodicalIF":4.2000,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Comprehensive Physiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/cphy.c220026","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PHYSIOLOGY","Score":null,"Total":0}
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Abstract
Renal function increases in pregnancy due to the significant hemodynamic demands of plasma volume expansion and the growing feto-placental unit. Therefore, compromised renal function increases the risk for adverse outcomes for pregnant women and their offspring. Acute kidney injury (AKI), or sudden loss of kidney function, is a significant event that requires aggressive clinical management. An AKI event in pregnancy, or in the postpartum period, significantly increases the risk of adverse pregnancy events and fetal and maternal mortality. At present, there are significant clinical challenges to the identification, diagnosis, and management of pregnancy-associated AKI due to changing hemodynamics in pregnancy that alter baseline values and to treatment limitations in pregnancy. Emerging data indicate that patients that are considered clinically recovered following AKI, which is currently assessed primarily by return of plasma creatinine levels to normal, maintain risk of long-term complications indicating that current recovery criteria mask the detection of subclinical renal damage. In association, recent large-scale clinical cohorts indicate that a history of AKI predisposes women to adverse pregnancy events even years after the patient is considered recovered from AKI. Mechanisms via which women develop AKI in pregnancy, or develop adverse pregnancy events post-AKI, are poorly understood and require significant study to better prevent and treat AKI in women. © 2023 American Physiological Society. Compr Physiol 13:4869-4878, 2023.
妊娠相关急性肾损伤的生理学。
由于血浆容量膨胀和胎儿-胎盘单位不断增长对血液动力学的巨大需求,妊娠期肾功能会增强。因此,肾功能受损会增加孕妇及其后代发生不良后果的风险。急性肾损伤(AKI)或肾功能突然丧失是需要积极临床治疗的重大事件。妊娠期或产后发生急性肾损伤会大大增加不良妊娠事件以及胎儿和产妇死亡的风险。目前,妊娠相关性 AKI 的识别、诊断和管理面临着巨大的临床挑战,这是因为妊娠期血流动力学的变化会改变基线值,而且妊娠期的治疗存在局限性。新的数据表明,目前主要通过血浆肌酐水平恢复正常来评估妊娠相关性肾损伤(AKI),但临床痊愈的患者仍有可能出现长期并发症,这表明目前的痊愈标准掩盖了对亚临床肾损伤的检测。此外,最近的大规模临床队列研究表明,有 AKI 病史的妇女即使在被认为从 AKI 中恢复多年后,仍容易发生不良妊娠事件。人们对妇女在妊娠期发生 AKI 或在 AKI 后发生不良妊娠事件的机制知之甚少,需要进行大量研究,以更好地预防和治疗妇女 AKI。© 2023 美国生理学会。Compr Physiol 13:4869-4878, 2023.
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