- Increase in the volume and size of the renal system:
- Kidney parenchyma
- Ureter caliber (This may lead to reflux and UTIs)
- Increase in renal blood flow and GFR
- Changes in tubular function
- Decreased serum osmolality and sCr
- Increased urinary glucose, bicarbonate, calcium, protein content
- Increase in sodium retention leading to water retention, which is crucial for the increase in plasma volume
- Physiologic hydronephrosis
- Decrease in BP in 1-2nd trimesters (due to decreased vascular resistance), increase in CO, and increase in RAAS activity
Pregnancy and AKI
The most common cause for AKI in pregnancy is pre-eclampsia (intra-renal AKI).
Other pregnancy-related causes include excessive vomiting and postpartum hemorrhage (pre-renal AKI).
Management is similar to normal AKI.