Women who’ve had a prior history of acute kidney history are at much greater risk of preeclampsia and other pregnancy complications – even if their kidney function seems to have returned to normal levels.
The team of researchers, headed by Dr. Jessica Sheehan Tangren at Massachusetts General Hospital’s Division of Nephrology, made a groundbreaking discovery that uncovers one of the many key factors involved in preeclampsia development.
What is Acute Kidney Injury (AKI)?
Acute kidney injury (AKI) is a pathology where the kidneys are suddenly damaged or fail. In the short term, this can lead to waste products accumulating in the blood, body fluid imbalance and impact the function of other organs – including the brain, heart and lungs. The condition can be caused by infections, sepsis, vasculitis, allergic reactions, low blood pressure and major surgery, among other factors.
Researchers have long known that existing kidney disease increases pregnancy complication risk in expectant mothers, but hadn’t – to this point – studied the effects of AKI.
What Risks does AKI Have for Pregnancy?
Researchers studied a large population of women and found that women with a prior history of acute kidney injury had a 5.9x higher risk of preeclampsia – even if they had a full clinical recovery from the injury (as tested by glomerular filtration rate tests). Among the control group, the risk of preeclampsia was about 4% – in the recovered AKI (r-AKI) group, the risk was 23%. AKI also increased the risk of babies born preterm or small-for-gestational-age – both of which are potential factors that contribute to birth injuries.
Even after adjusting for confounding factors, women with r-AKI were 2.4x more likely to have adverse fetal outcomes and 5.9x more likely to have preeclampsia.
Why Is R-AKI a Risk Factor for Preeclampsia and Other Adverse Pregnancy Outcomes?
The researchers haven’t yet elucidated why r-AKI increases adverse outcome risk, only that the risk is significantly greater. They do posit, however, a preliminary explanation: when kidneys recover from injury, there are changes in the small blood vessels of the organs that can decrease the kidney’s ability to function well during pregnancy. Research has long confirmed that pregnancy causes major changes in the kidney, and these changes are a sort of ‘renal stress test’ that can reveal previously undetected kidney disease.
What Should Doctors Be Doing When Screening Expectant Mother’s Health?
It is very important that physicians properly screen mothers for any health conditions that could increase pregnancy risk, and this new research highlights the importance of monitoring pregnant women with a history of AKI to ensure that any possible preeclampsia is appropriately managed and treated. According to Dr. Tangren, “ Our findings that women with a history of acute kidney injury were at increased risk of complications including preeclampsia are important, because all of these women appeared to have recovered from their kidney injury prior to pregnancy…They would not necessarily have been identified as at high risk for pregnancy complications.” [Emphasis added].
According to study co-author Dr. Jeffrey Ecker, Chief of Obstetrics and Gynecology at MGH, “Information like this helps obstetric providers know what to be vigilant for in pregnant women with a history of acute kidney injury and indicates that asking about such history is important…Being especially watchful for signs and symptoms of preeclampsia in such patients is one immediate application of this work.”
He further comments: “In a longer view, work like this offers important hypotheses for future study. Can interventions in patients with a history of acute kidney injury prevent complications like preeclampsia? Taking a baby aspirin each day during pregnancy is recommended for some women at high risk for preeclampsia. Should such preventive treatment be used in women with a history of acute kidney injury? Questions like this deserve further thought and study.”
Did you Develop Preeclampsia After Recovered Acute Kidney Injury?
If you had preeclampsia during your pregnancy and your child has developmental delays, it is possible that medical malpractice may have been involved. The law offices of Reiter & Walsh ABC Law Centers would be happy to speak with you about reviewing your case records and finding out the cause of your child’s developmental disabilities. Your information is always kept in the strictest confidence. Please don’t hesitate to reach out to us today.
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- J. S. Tangren, C. E. Powe, E. Ankers, J. Ecker, K. Bramham, M. A. Hladunewich, S. A. Karumanchi, R. Thadhani. Pregnancy Outcomes after Clinical Recovery from AKI. Journal of the American Society of Nephrology, 2016; DOI: 10.1681/ASN.2016070806 (URL: http://jasn.asnjournals.org/content/early/2016/12/21/ASN.2016070806)