Renal Dysfunction in Pre-eclampsia: Etiology, Pathogenesis, Diagnosis and Perioperative Management: A Narrative Review

Abstract

Preeclampsia and preeclampsia-associated renal dysfunction (PARD) are severe morbidities during pregnancy with potentially devastating maternal and fetal outcomes. PARD has various aetiologies; understanding the physiological renal adaptation during pregnancy is paramount for early detection, diagnosis, and appropriate management to minimise maternal and fetal morbidities and mortalities. In this article, we review the current medical literature on PARD. We conducted a literature review using PubMed MEDLINE and ScienceDirect electronic databases. We accessed published work on the pathogenesis of renal dysfunction in preeclampsia and its management from 2005 to 2020. We aimed to highlight possible perioperative management strategies based on the pathophysiological derangements of preeclampsia. We used the following search terms: preeclampsia, renal dysfunction, pathogenesis, and perioperative management. Most of the studies we reviewed were either observational (both prospective and retrospective) or translational research studies. We also outline the primary perioperative (peri-delivery) course and discuss management options as advised by leading international societies and their challenges and considerations.