Miscarriage-Related Acute Kidney Injury: A Case Report

Abstract

Background

Pregnancy-related acute kidney injury (Pr-AKI) is associated with significant maternal and fetal morbidity and mortality, with a three- to four-fold increase in perinatal mortality. Pr-AKI can arise from various obstetric complications, such as hyperemesis gravidarum, septic abortion, hypertensive disorders of pregnancy, pyelonephritis, and antiphospholipid antibody syndrome. Therefore, early diagnosis and appropriate intervention, including the identification of the underlying etiology, are important to effectively manage Pr-AKI. Therefore, we report a case of Pr-AKI after early miscarriage in a patient without hyperemesis gravidarum or septic abortion whose renal function gradually improved postoperatively for miscarriage.

Case Presentation

A 34-year-old primigravid woman was referred to us for perinatal management at 6 weeks of gestation. Unfortunately, she was diagnosed with miscarriage 1 week later. The patient had no history of hyperemesis gravidarum or septic abortion; however, she developed oliguria, and her serum creatinine and blood urea nitrogen levels were abnormally increased. Consequently, she underwent a renal biopsy to evaluate renal dysfunction, which indicated tubulointerstitial damage. The patient also underwent manual vacuum aspiration for a miscarriage. Postoperatively, her urine output increased, and her renal function improved. She was determined to have experienced Pr-AKI due to her miscarriage.

Conclusion

Our patient had Pr-AKI after a miscarriage in the absence of other causes. This case report highlights the presence of unknown causes of Pr-AKI, warranting further research for the development of preventive interventions.

Keywords:

• pregnancy-related acute kidney injury
• miscarriage
• missed abortion
• creatinine
• renal insufficiency

Abbreviations

HDP, hypertensive disorders of pregnancy; Pr-AKI, pregnancy-related acute kidney injury; AKI, acute kidney injury; RIFLE, Risk, Injury, Failure, Loss of kidney function, and End-stage renal disease; KDIGO, Kidney Disease: Improving Global Outcomes; AKIN, Acute Kidney Injury Network; ANCA, anti-neutrophil cytoplasmic antibodies.

Ethics Approval and Informed Consent

Institutional approval was not required to publish this case report.

Consent for Publication

The patient provided her written permission for the publication of her clinical information and clinical photos.

Acknowledgments

We are grateful to the patient and her family for their cooperation, and we acknowledge all our colleagues who helped us produce this article.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no competing interests in this work.

Additional information

Funding

This study was supported by Grant-in-Aid for Scientific Research C (M Ono, 22K09556) and Grant-in-Aid for Early-Career Scientists (J Kojima, 22K16866) from the Ministry of Education, Culture, Sports, Science and Technology.