During pregnancy, the development of acute renal failure is especially daunting because two lives are involved and at risk. The outcomes of acute kidney injury (AKI), as in other settings, can be quite poor, with significant morbidity and mortality rates of 20–30 percent.
Variable definitions of AKI have been used for pregnancy. The normal baseline serum creatinine during pregnancy is approximately 0.5 mg/dL; thus, a rise over 48 hours to values greater than 1.0 mg/dL, or an increase from a baseline of more than 0.5 mg/dL in 48 hours, should trigger further evaluation for AKI. It has been suggested that the RIFLE criteria be used, focusing on the percent change in creatinine or the development of oliguria to define AKI in pregnancy (1), but validation is needed. Regardless, there is clear evidence that the incidence of AKI in pregnancy has fallen over the past several decades, likely because of improved access to prenatal care and emergency services for the care of obstetric complications in developing countries and among disadvantaged populations. Still, in some less developed nations, the rates of AKI related to septic abortion and other infectious and hemorrhagic complications remain high (2). Presently, the incidence of AKI in pregnancy has fallen to approximately 1 in 15,000 pregnancies (3), but the outcomes have not significantly improved (3, 4).
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