Acute Kidney Injury in Pregnancy among Kidney Transplant Recipients

Acute kidney injury (AKI) in pregnancy among women with kidney transplants is rarely addressed in the literature. There is no consensus definition of AKI among this population, and limited data exist on the different aetiologies and outcomes, thereby creating a significant knowledge gap. Pregnancy among patients with a kidney transplant is considered high risk due to the possibility of foetal and maternal risks, AKI and graft loss during pregnancy. This is a case series report of two post-kidney transplant patients who developed multiple episodes of AKI in the course of pregnancy. There was no identifiable pre-renal, intrinsic renal, post-renal or transplant-specific cause for the AKI. There was a failure of the first-trimester dip in serum creatinine in both patients. In addition, the serum creatinine stabilised between 6 and 12 months post-delivery, albeit at a higher level. The renal biopsy done was negative for rejection or polyoma virus nephropathy. Failure of the first trimester dip in serum creatinine may be a risk factor for AKI in pregnant transplant patient which may in turn have deleterious short term and long term outcomes on kidney function.