• Chronic kidney disease
• Cystatin-C
• Estimated glomerular filtration rate
• Genome‑wide association study

• Adult
• Female
• Humans
• Middle Aged
• China
• Creatinine/blood
• Cystatin C/genetics
• East Asian People/genetics
• Genome-Wide Association Study
• Glomerular Filtration Rate/genetics
• Kidney/metabolism
• Polymorphism, Single Nucleotide
• Renal Insufficiency, Chronic/genetics

• CQYC202005003 Chongqing Talents: Exceptional Young Talents Project
• 82373643 and 8217121613 the National Natural Science Foundation of China
• cstc2020jcyjjqX0014 the Outstanding Youth Science Fund of Chongqing
• Grant No. 2018YFC2000703 the National Key Research and Development Program of China

Preeclampsia is a multifactorial condition associated with significant morbidity and mortality. Fluid therapy in these patients is challenging since volume expansion may precipitate pulmonary edema, and fluid restriction may worsen renal function. Furthermore, cardiac impairment may introduce an additional component to the hemodynamic management. This article reviews the repercussions of preeclampsia on renal and cardiovascular systems and the development of pulmonary edema, as well as to discuss fluid management, focusing on the mitigation of adverse outcomes and monitoring alternatives. The literature review was carried out using PubMed, Embase, and Google Scholar databases from May 2019 to March 2020. Papers addressing the subjects of interest were included regardless of the publication language. There is a current trend towards restricting the administration of fluids in women with non-complicated preeclampsia. However, patients with preeclampsia may experience hemorrhagic shock, requiring volume resuscitation. In this case, hemodynamic monitoring is recommended to guide fluid therapy while avoiding complications.

• Acute kidney injury
• Cardiovascular
• Fluid management
• Preeclampsia
• Pulmonary edema
• Review article

Acute kidney injury that occurs during pregnancy or in the post-partum period (PR-AKI) is a serious obstetric complication with risk of significant associated maternal and fetal morbidity and mortality. Recent data indicates that the incidence of PR-AKI is increasing, although accurate calculation is limited by the lack of a uniform diagnostic criteria that is validated in pregnancy. Hypertensive and thrombotic microangiopathic disorders of pregnancy have been identified as major contributors to the burden of PR-AKI. As is now accepted regarding preeclampsia, HELLP syndrome and atypical hemolytic uremic syndrome, it is believed that PR-AKI may have long-term renal, cardiovascular and neurocognitive consequences that persist beyond the post-partum period. Further research regarding PR-AKI could be advanced by the development of a pregnancy-specific validated definition and classification system; and the establishment of refined animal models that would allow researchers to further elucidate the mechanisms and sequelae of the disorder.

• acute kidney injury (AKI)
• chronic kidney disease (CKD)
• hemolysis elevated liver enzymes low platelet count (HELLP)
• preeclampsia
• renal injury

• fatty liver
• liver failure
• patient outcome assessment
• pregnancy complications
• risk factors

• AKI in pregnancy
• Acute fatty liver of pregnancy
• hemolysis elevated liver enzymes and low platelet count syndrome
• preeclampsia
• thrombotic microangiopathy

Organ failure is the most important determinant of the severity of acute pancreatitis (AP). Soluble fms-like tyrosine kinase 1 (sFlt-1) is positively associated with organ failure in sepsis. Our aim was to evaluate the diagnostic utility of automated sFlt-1 measurements for early prediction of AP severity. Adult patients (66) with AP were recruited, including 46 with mild (MAP), 15 with moderately-severe (MSAP) and 5 with severe AP (SAP). Serum and urine samples were collected twice. Serum sFlt-1 was measured with automated electrochemiluminescence immunoassay. Serum concentrations of sFlt-1 were significantly higher in patients with MSAP and SAP as compared to MAP. SAP patients had the highest concentrations. At 24 and 48 h, sFlt-1 positively correlated with inflammatory markers (leukocyte count, C-reactive protein), kidney function (creatinine, urea, cystatin C, serum and urine neutrophil gelatinase-associated lipocalin, urine albumin/creatinine ratio), D-dimer and angiopoietin-2. sFlt-1 positively correlated with the bedside index of severity in AP (BISAP) score and the duration of hospital stay. Serum sFlt-1 above 139 pg/mL predicted more severe AP (MSAP + SAP). In the early phase of AP, sFlt-1 is positively associated with the severity of AP and predicts organ failure, in particular kidney failure. Serum sFlt-1 may be a practical way to improve early assessment of AP severity.

• acute pancreatitis
• angiopoietin-2
• diagnostic utility
• endothelial dysfunction
• vascular endothelial growth factor receptor 1

• Acute Disease
• Adult
• Aged
• Angiopoietin-2/blood
• Biomarkers/blood
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Pancreatitis/blood
• Pancreatitis/pathology
• Severity of Illness Index
• Time Factors
• Vascular Endothelial Growth Factor Receptor-1/blood

Hemolytic-uremic syndrome (HUS) presents with hemolytic anemia, thrombocytopenia, and thrombotic microangiopathy of the kidney and usually results from Shiga-toxin induced activation of the alternative complement pathway. Gastroenteritis is a common feature of the Shiga-toxin producing Escherichia coli HUS, referred to as STEC-HUS. An inherited or acquired complement dysregulation may lead to HUS referred to as non-STEC or atypical (a)HUS. Although gastroenteritis is not a common presentation of aHUS, some patients develop ischemic colitis and may be misdiagnosed as acute appendicitis or acute ulcerative colitis (UC).

We present a patient with low circulating complement (C) 3 levels who developed aHUS in the course of chronic active UC. Resolution of renal and gastrointestinal manifestations in response to treatment with eculizumab, a humanized monoclonal antibody against terminal C5 protein suggests the role of alternative complement in the pathogenesis of both, aHUS and UC.

This case illustrates that dysregulation of the alternative complement pathway may manifest in other organs besides the kidney and that the circulating C3 levels do not correlate with the disease activity or the clinical response to eculizumab.

• Hemolytic–uremic syndrome (HUS)
• acute kidney injury (AKI)
• inflammatory bowel disease (IBD)
• membrane attack complex (MAC)
• thrombotic microangiopathy (TMA)
• ulcerative colitis (UC)

AIM: To evaluate the prognosis of patients with acute fatty liver of pregnancy (AFLP) 6 mo or longer after discharge.

METHODS: The records of pregnant patients diagnosed with AFLP at Beijing Ditan Hospital over a 16-year period were reviewed in November 2012. Patients were monitored using abdominal ultrasound, liver and kidney functions, and routine blood examination.

RESULTS: A total of 42 patients were diagnosed with AFLP during the study period, and 25 were followed. The mean follow-up duration was 54.5 mo (range: 6.5-181 mo). All patients were in good physical condition, but one patient had gestational diabetes. The renal and liver functions normalized in all patients after recovery, including in those with pre-existing liver or kidney failure. The ultrasound findings were normal in 12 patients, an increasingly coarsened echo-pattern and increased echogenicity of the liver in 10 patients, and mild to moderate fatty liver infiltration in 3 patients. Cirrhosis or liver nodules were not observed in any patient.

CONCLUSION: Acute liver failure and acute renal failure in AFLP patients is reversible. Patients do not require any specific long-term follow-up after recovery from AFLP if their liver function tests have normalized and they remain well.

• Acute fatty liver of pregnancy
• Acute liver failure
• Acute renal failure
• Follow-up study

• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/etiology
• Acute Kidney Injury/physiopathology
• Acute Kidney Injury/therapy
• Adult
• Biomarkers/blood
• China
• Disease Progression
• Fatty Liver/blood
• Fatty Liver/diagnosis
• Fatty Liver/etiology
• Fatty Liver/therapy
• Female
• Follow-Up Studies
• Humans
• Kidney Function Tests
• Liver Failure, Acute/diagnosis
• Liver Failure, Acute/etiology
• Liver Failure, Acute/physiopathology
• Liver Failure, Acute/therapy
• Liver Function Tests
• Predictive Value of Tests
• Pregnancy
• Pregnancy Complications/blood
• Pregnancy Complications/diagnosis
• Pregnancy Complications/etiology
• Pregnancy Complications/therapy
• Prognosis
• Prospective Studies
• Recovery of Function
• Time Factors
• Young Adult

Even in developed countries, severe specific pregnancy complications may occur in the immediate postpartum period and require admission to the ICU. The characteristics and risk factors of acute renal failure (ARF) induced by these complications and their treatments are not well known.

We performed a retrospective multicenter study in three intensive care departments linked to level III maternity wards in the north of France. All patients admitted to ICU for postpartum complications over a 5-year period (2008 to 2012) were included. Clinical and biological data, delivery characteristics, type of complications, and treatments were compared by univariate and multivariate analyses according to the occurrence and severity of ARF.

One hundred eighty-two patients admitted to ICU for postpartum complications were included in the study. Sixty-eight patients (37%) developed an ARF: 49 with a low or medium severity and 19 with a severe ARF requiring renal replacement therapy. Hemolysis, elevated liver enzyme, and low platelet count (HELLP) syndrome on its own (p = 0.047) or combined with postpartum haemorrhage (p = 0.003), previous treatment by hyperoncotic albumin infusion (p = 0.001) and blockade of fibrinolysis by tranexamic acid (p = 0.03), was associated with secondary ARF. By multivariate analysis, the only independent factors were the association of HELLP syndrome with postpartum haemorrhage and the use of hyperoncotic albumin infusion.

HELLP syndrome associated with postpartum haemorrhage induces a high risk of ARF in the complicated postpartum setting. A particular attention should be given to treatments that could worsen the kidney function in that situation.

• Acute renal failure
• HELLP syndrome
• Hyperoncotic albumin
• Intensive care
• Postpartum complications
• Postpartum haemorrhage
• Pregnancy
• Tranexamic acid

• MYASTHENIA

• hypertension
• pregnancy
• renal disease

• Female
• Global Health
• Humans
• Hypertension/epidemiology
• Kidney Diseases/epidemiology
• Morbidity/trends
• Pregnancy
• Pregnancy Complications/epidemiology

A 23-year-old G1P0000 without prior past medical history is 31 weeks pregnant with prenatal care presents with complaints of worsening leg and face swelling for the past 2 days now seeks care because of headache, diarrhea, nausea, and vomiting. On exam she is found to have a blood pressure of 120/86, edema, and brisk deep tendon reflexes. Laboratory testing revealed hemoglobin 11.3 g/dl, platelet count 141,000/μl white blood count 18,000/μl, creatinine 1.1 mg/dl, aspartate aminotransferases (AST) 65 U/l, lactate dehydrogenase (LDH) 400 U/l, total bilirubin 1.1 mg/dl, prothrombin time (PT) 14.7 s, ammonia of 90 mcg/dl, blood glucose 139 mg/dl, calcium 7.3 mg/dl, and uric acid of 6.0 mg/dl. The urinalysis demonstrated WBC’s 3–5/hpf, RBC’s 3–5/hpf—non-dysmorphic, renal tubular epithelial cells were seen and a urine protein to creatinine ratio of 2. One day after hospitalization the patient’s blood pressure was 145/87 with a similar blood pressure 6 h later.

• Acute kidney injury
• kidney disease
• preeclampsia
• pregnancy
• renal cortical necrosis