切换至 "中华医学电子期刊资源库"

中华产科急救电子杂志 ›› 2025, Vol. 14 ›› Issue (04) : 210 -214. doi: 10.3877/cma.j.issn.2095-3259.2025.04.004

妊娠期并发症对女性全生命周期影响

严重产后出血对女性肾功能的近远期影响
罗郸琳1, 赫英东1,2,()   
  1. 1北京大学第一医院妇产生殖医学中心,北京 100034
    2北京大学第一医院宁夏妇女儿童医院妇产科,银川 750011
  • 收稿日期:2025-06-18 出版日期:2025-11-18
  • 通信作者: 赫英东
  • 基金资助:
    宁夏回族自治区重点研发项目(2024BEG02021)

Short-term and long-term effects of severe postpartum hemorrhage on women's renal function

Danlin Luo, Yingdong He()   

  • Received:2025-06-18 Published:2025-11-18
  • Corresponding author: Yingdong He
引用本文:

罗郸琳, 赫英东. 严重产后出血对女性肾功能的近远期影响[J/OL]. 中华产科急救电子杂志, 2025, 14(04): 210-214.

Danlin Luo, Yingdong He. Short-term and long-term effects of severe postpartum hemorrhage on women's renal function[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2025, 14(04): 210-214.

严重产后出血导致母体远期肾脏损伤多继发于围产期急性肾损伤。产后出血导致急性肾损伤常见原因为急性肾小管坏死、急性肾皮质坏死、弥散性血管内凝血及补体介导的血栓性微血管病。本文将对严重产后出血造成孕产妇急性肾功能损伤及对其远期肾功能影响的相关内容进行介绍。

Long-term maternal renal injury following severe postpartum hemorrhage is predominantly secondary to acute kidney injury (AKI) during the perinatal period. Common causes of AKI due to postpartum hemorrhage include acute tubular necrosis, acute renal cortical necrosis, disseminated intravascular coagulation, and complement-mediated thrombotic microangiopathy. This article reviews the acute renal impairment associated with severe postpartum hemorrhage and its long-term effects on materal renal function.

[1]
Parikh NI, Gonzalez JM, Anderson CAM, et al. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women: a scientific statement from the American Heart Association[J]. Circulation2021143(18):e902-916.
[2]
Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group[J]. Crit Care20048(4):R204-212.
[3]
Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury[J]. Crit Care200711(2):R31.
[4]
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury[J]. Nephron Clin Pract2012120(4):c179-184.
[5]
Harel Z, McArthur E, Hladunewich M, et al. Serum creatinine levels before, during, and after pregnancy[J]. JAMA2019321(2):205-207.
[6]
Shah S, Meganathan K, Christianson AL, et al. Pregnancy-related acute kidney injury in the United States: clinical outcomes and health care utilization[J]. Am J Nephrol202051(3):216-226.
[7]
Liu Y, Bao H, Jiang Z, et al. Pregnancy-related acute kidney injury and a review of the literature in China[J]. Intern Med201554(14):1695-1703.
[8]
Chowdhary PK, Tibrewal A, Kale SA. Postpartum acute kidney injury in tertiary care center: single-center experience from central India[J]. Saudi J Kidney Dis Transpl202132(4):1111-1117.
[9]
Coles H, Steer P, Hughes P, et al. Factors associated with acute kidney injury during delivery or the postpartum period: a case control study[J]. Eur J Obstet Gynecol Reprod Biol2021261:200-204.
[10]
赫英东,于峰. 补体检测在妊娠相关血栓性微血管病诊治中的价值[J]. 中华检验医学杂志2019(12):986-989.
[11]
WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial[J]. Lancet2017389(10084):2105-2116.
[12]
Chornenki NLJ, Um KJ, Mendoza PA, et al. Risk of venous and arterial thrombosis in non-surgical patients receiving systemic tranexamic acid: a systematic review and meta-analysis[J]. Thromb Res2019179:81-86.
[13]
Taeuber I, Weibel S, Herrmann E, et al. Association of intravenous tranexamic acid with thromboembolic events and mortality: a systematic review, meta-analysis, and meta-regression[J]. JAMA Surg2021:e210884.
[14]
Berri J, Donnette MLQ, Millet I, et al. Tranexamic acid-induced acute bilateral renal cortical necrosis in a young trauma patient: a case report and literature review[J]. BMC Nephrol202526(1):95.
[15]
Odabaş AR, Çetinkaya R, Selçuk Y, et al. Tranexamic-acid-induced acute renal cortical necrosis in a patient with haemophilia A[J]. Nephrol Dial Transplant200116(1):189-190.
[16]
Wiles K, Webster P, Seed PT, et al. The impact of chronic kidney disease Stages 3-5 on pregnancy outcomes[J]. Nephrol Dial Transplant202136(11):2008-2017.
[17]
Li Z, Chen S, Tan Y, et al. The effect of preeclampsia on long-term kidney function among pregnant women with chronic kidney disease[J]. Nephrol Dial Transplant202540(2):393-404.
[18]
Liu Y, Ma X, Zheng J, et al. Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis[J]. BMC Pregnancy Childbirth201717(1):235.
[19]
Hildebrand AM, Liu K, Shariff SZ, et al. Characteristics and outcomes of AKI treated with dialysis during pregnancy and the postpartum period[J]. J Am Soc Nephrol201526(12):3085-3091.
[20]
Lipkind HS, Zuckerwise LC, Turner EB, et al. Severe maternal morbidity during delivery hospitalisation in a large international administrative database, 2008-2013: a retrospective cohort[J]. BJOG2019126(10):1223-1230.
[21]
Creanga AA, Berg CJ, Ko JY, et al. Maternal mortality and morbidity in the United States: where are we now?[J]. J Womens Health (Larchmt)201423(1):3-9.
[22]
Hossain N, Paidas MJ. Disseminated intravascular coagulation[J]. Semin Perinatol201337(4):257-266.
[23]
Van Cott EM, Laposata M. Laboratory evaluation of hypercoagulable states[J]. Hematol Oncol Clin North Am199812(6):1141-1166.
[24]
Ribes EA, Doménech JC, Nicolás JMM, et al. Risk of acute renal failure associated with disseminated intravascular coagulation[J]. Br Med J19753(5986):745.
[25]
Zech P, Béruard M, Ducluzeau R, et al. Evolution des insuffisances rénales aiguës avec coagulation intravasculaire [Evolution of acute kidney failure with intravascular coagulation][J]. J Urol Nephrol (Paris)197278(4):337-341.
[26]
Stratta P, Canavese C, Colla L, et al. The role of intravascular coagulation in pregnancy related acute renal failure[J]. Arch Gynecol Obstet1988243(4):207-214.
[27]
Stratta P, Besso L, Canavese C, et al. Is pregnancy-related acute renal failure a disappearing clinical entity?[J]. Ren Fail199618(4):575-584.
[28]
Stratta P, Canavese C, Dogliani M, et al. Pregnancy-related acute renal failure[J]. Clin Nephrol198932(1):14-20.
[29]
Zhao Z, Zhang J, Li N, et al. Disseminated intravascular coagulation associated organ failure in obstetric patients admitted to intensive care units: a multicenter study in China[J]. Sci Rep202111(1):16379.
[30]
Prakash J, Vohra R, Wani IA, et al. Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: a single-centre experience of 22 years from Eastern India[J]. Nephrol Dial Transplant200722(4):1213-1217.
[31]
Kleinknecht D, Grünfeld JP, Gomez PC, et al. Diagnostic procedures and long-term prognosis in bilateral renal cortical necrosis[J]. Kidney Int19734(6):390-400.
[32]
Sahay M, Swarnalata, Swain M, et al. Renal cortical necrosis in tropics[J]. Saudi J Kidney Dis Transpl201324(4):725-730.
[33]
Fakhouri F, Scully M, Provôt F, et al. Management of thrombotic microangiopathy in pregnancy and postpartum: report from an international working group[J]. Blood2020136(19):2103-2117.
[34]
Frimat M, Decambron M, Lebas C, et al. Renal cortical necrosis in postpartum hemorrhage: a case series[J]. Am J Kidney Dis201668(1):50-57.
[35]
Prakash J, Sen D, Kumar NS, et al. Acute renal failure due to intrinsic renal diseases: review of 1122 cases[J]. Ren Fail200325(2):225-233.
[36]
Wang R, Liu X, Li W, et al. Pregnancy-associated renal cortical necrosis and nonenhanced functional magnetic resonance imaging: a case series[J]. Kidney Med20235(5):100623.
[37]
Gurevich-Shapiro A, Orbach-Zinger S, Leader A, et al. Complement-mediated hemolytic uremic syndrome associated with postpartum hemorrhage: case series and systematic review of individual participant data[J]. Res Pract Thromb Haemost20248(8):102579.
[38]
Bruel A, Kavanagh D, Noris M, et al. Hemolytic uremic syndrome in pregnancy and postpartum[J]. Clin J Am Soc Nephrol201712(8):1237-1247.
[39]
Dobyne A, Jones B, Ita N, et al. Atypical HELLP syndrome in a hydatidiform molar pregnancy: a case report [J]. Med J Obstet Gynecol, 2015, 3(4): 1064.
[40]
非典型溶血尿毒综合征多学科共识协作组. 非典型溶血尿毒综合征多学科诊疗实践专家共识(2025版)[J]. 中华内科杂志202564(5):396-411.
[41]
Kelly RJ, Höchsmann B, Szer J, et al. Eculizumab in pregnant patients with paroxysmal nocturnal hemoglobinuria[J]. N Engl J Med2015373(11):1032-1039.
[42]
Kaufeld JK, Kühne L, Schönermarck U, et al. Features of postpartum hemorrhage-associated thrombotic microangiopathy and role of short-term complement inhibition[J]. Kidney Int Rep20249(4):919-928.
[1] 罗兵, 董凤群, 牛艺臻, 王锟, 程志华, 刘宏强. 胎儿超声心动图在单纯性肺动脉瓣狭窄及预后评估中的价值[J/OL]. 中华医学超声杂志(电子版), 2025, 22(08): 740-747.
[2] 金烨莹, 王艺璇, 杨瑞. 基于单细胞RNA测序的乳腺癌肿瘤相关巨噬细胞亚群鉴定与临床预后分析[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(06): 339-347.
[3] 毛俊, 蔡兆伦, 尹晓南, 沈朝勇, 张波. 影像组学预测模型在胃肠间质瘤诊断及预后中的研究进展[J/OL]. 中华普通外科学文献(电子版), 2025, 19(06): 421-425.
[4] 许舜, 汪瀚, 胡涛, 钱梦佳, 崔一尧, 陈信浩. 两种术式治疗胆总管中下段结石合并急性胆管炎患者疗效及预后比较[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(01): 38-41.
[5] 贺雅莉, 黄丽, 杨培娟. 功能保留手术在低位直肠癌治疗中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 701-704.
[6] 田超, 黄若曦, 蒋茂林, 谢崇伟, 刁鹏飞, 钟苏权, 陈东, 王航涛, 陈桂柳, 陈虞娟, 李国良. 不同亚型前列腺癌新辅助化疗后盆腔淋巴结转移的风险因素及时间分布[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(06): 727-735.
[7] 周福安, 陈戬. 经皮肾镜碎石取石术后肾功能恶化的围术期影响因素研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(06): 792-795.
[8] 许志翱, 顾丽萍, 曹敏, 宣梦馨, 李艳婷, 赵丽亭. 基于加速康复外科和预康复模式对老年肺癌围术期多维度管理干预及预后的影响[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(06): 979-984.
[9] 刘建鹏, 严丽燕, 冯少婷, 黄鹏, 梁开丽, 方鸿飞. D-二聚体、肌钙蛋白及氨基末端脑利钠肽前体在急性肺栓塞预后中的临床意义研究[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(06): 1019-1022.
[10] 杨刚, 黄徐建, 朱建交, 熊永福, 李敬东. 两种不同类型肝门周围胆管癌临床病理特征及生存预后[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 931-938.
[11] 吴刚, 严燃星, 严鑫, 阎婧, 何跃明, 朱倩. 基于血清和组织外泌体多组学分析筛选胰腺癌诊断和预后标志物[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 962-972.
[12] 刘娜, 盛华, 高超. 机械通气与急性肾损伤:从机制到临床实践[J/OL]. 中华肾病研究电子杂志, 2025, 14(06): 345-350.
[13] 袁慧, 周芦忠, 汤鹤年, 潘菊花. LMR与PHR对射频消融术后肝细胞癌患者预后的评估[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(06): 635-641.
[14] 刘艳晶, 解祥军, 魏志. 术前丙氨酸氨基转移酶/天冬氨酸氨基转移酶比值与消化道肿瘤预后的关系[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(06): 655-660.
[15] 高兴梅, 周洁容, 杨溢, 张孟祥, 张仲谋, 李斌. 重症肺炎患者血磷水平轨迹与短期预后之间的关系[J/OL]. 中华临床医师杂志(电子版), 2025, 19(07): 479-485.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?