Thread by @iamnephrologist

🌸NephroTips on AKI in Pregnancy (1/6)
#Tweetorial for budding Nephrologists

🔥Seven-point differential assessment

1️⃣Period of gestation
2️⃣Prodromal symptom
3️⃣Coagulopathy
4️⃣LFT
5️⃣Platelets
6️⃣Hemolysis evidence
7️⃣Hypertension

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🌸NephroTips on AKI in Pregnancy (2/6)

♨️AFLP

1️⃣>34 Week
2️⃣Vomiting
3️⃣only in severe cases
4️⃣Jaundice
5️⃣Normal platelet
6️⃣Hemolysis absent
7️⃣Hypertension absent

💡Polyuria‼️ d/t 🚫hepatic metabolism of placental Vasopressinase

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🌸NephroTips on AKI in Pregnancy (3/6)

♨️HELLP

1️⃣Mostly 1st 48 hr postpartum
2️⃣severe pre-eclampsia
3️⃣20% cases
4️⃣SGOT/PT⬆️
5️⃣Plt<1lakh
6️⃣LDH>600
7️⃣Severe HTN

⚠️Also has ⬇️ADAMTS13 level‼️
💡Variable degree renal failure

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🌸NephroTips on AKI in Pregnancy (4/6)

♨️TTP

1️⃣Average 26wk
2️⃣Pentad (remember❓)
3️⃣None‼️
4️⃣LFT normal‼️
5️⃣Profound thrombocytopenia
6️⃣+
7️⃣+

⚠️Hallmark of TTP/HUS- Normal coagulation
💡ADAMTS13 severely⬇️(<5%)
💡AKI in 30-80%

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🌸NephroTips on AKI in Pregnancy (5/6)

♨️HUS

1️⃣70% postpartum‼️
2️⃣Uremia
3️⃣None
4️⃣LFT normal
5️⃣Profound thrombocytopenia
6️⃣+
7️⃣+

⚠️Placental expression of complement regulatory protein protective in prepartum
💡Predominant AKI

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🌸NephroTips on AKI in Pregnancy (6/6)

♨️Acute Cortical Necrosis

1️⃣Usually postpartum
2️⃣Gross hematuria👉Anuria
3️⃣Consumptive if DIC
4️⃣Normal
5️⃣If DIC⬇️
6️⃣Absent
7️⃣Absent

⚠️Initiating event- DIC/ Severe renal ischemia

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