Postpartum acute kidney injury — emergency management and RRT decision station

Resuscitation station on pregnancy-related AKI stage 3 after PPH with sepsis. Tests KDIGO recognition against the pregnant baseline, immediate management of hyperkalaemia and acidosis, the avoidance of nephrotoxins, the AEIOU indications for RRT, and the multidisciplinary decision. Includes assessor key and marking domains.

Prompt

A 33-year-old G2P2, day 2 after a forceps delivery complicated by primary postpartum haemorrhage of 2500 mL (atonic, managed with the uterotonic ladder, tranexamic acid and an intrauterine Bakri balloon) and now pyrexial with a wound infection, is oliguric at 18 mL/h despite fluid challenge. Creatinine has risen from 60 to 168 micromol/L in 48 hours; potassium 6.4 mmol/L; pH 7.26; bicarbonate 14 mmol/L; lactate 3.2 mmol/L. HR 118, BP 102/60, RR 24, SpO2 95%. You are the obstetric registrar; the consultant is 20 minutes away.

Station brief

Format. Resuscitation and RRT-decision station, approximately 12 minutes. You are the obstetric registrar. The midwife and a junior doctor are with you; the obstetric consultant and the on-call nephrologist are 15–20 minutes away and have been called. The assessor will run the clock and feed you new observations. ^[3]

Candidate instruction. Lead the recognition and immediate management of pregnancy-related AKI stage 3 after PPH with sepsis. Verbalise the KDIGO recognition against the pregnant baseline, the immediate management of hyperkalaemia and acidosis, the avoidance of nephrotoxins, the AEIOU indications for RRT, and the multidisciplinary decision. ^[1]^[3]

References6Show

[1]Kellum JA, Lameire N; KDIGO AKI Guideline Work Group Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1) Crit Care, 2013.PMID 23394211
[2]Jim B, Garovic VD Acute Kidney Injury in Pregnancy Semin Nephrol, 2017.PMID 28711077
[3]Nelson-Piercy C, Srisawat N, Kashani K, Lumlertgul N, Murugan R, Rhee H, Chakravarthi R, Surapaneni T, Acharya A, Ankawi G, Bramham K, Cerda J, Clark K, Claure-Del Granado R, Gowrishankar S, Luyckx V, Menon S, Poli-de-Figueiredo CE, Ramachandran R, Sahay M, Samavedam S, Shemies R, Shetty MS, Wiles K, Wium L, Wu VC, Yadla M, Ronco C, Mehta RL, Ostermann M Pregnancy-associated acute kidney injury - consensus report of the 32nd Acute Disease Quality Initiative workgroup Nat Rev Nephrol, 2025.PMID 40681846
[4]Lumlertgul N, Claure-Del Granado R, Acharya A, Ankawi G, Gowrishankar S, Ronco C, Mehta RL, Nelson-Piercy C, Ostermann M Diagnosis, diagnostic approach and challenges in pregnancy-associated AKI-the ADQI 32 consensus meeting Nephrol Dial Transplant, 2026.PMID 41143732
[5]Costantine MM Physiologic and pharmacokinetic changes in pregnancy Front Pharmacol, 2014.PMID 24772083
[6]Chu J, Johnston TA, Geoghegan J Maternal Collapse in Pregnancy and the Puerperium: Green-top Guideline No. 56 BJOG, 2020.PMID 31845507

Postpartum acute kidney injury — emergency management and RRT decision station

Station brief

References6Show

[1]Kellum JA, Lameire N; KDIGO AKI Guideline Work Group Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1) Crit Care, 2013.PMID 23394211
[2]Jim B, Garovic VD Acute Kidney Injury in Pregnancy Semin Nephrol, 2017.PMID 28711077
[3]Nelson-Piercy C, Srisawat N, Kashani K, Lumlertgul N, Murugan R, Rhee H, Chakravarthi R, Surapaneni T, Acharya A, Ankawi G, Bramham K, Cerda J, Clark K, Claure-Del Granado R, Gowrishankar S, Luyckx V, Menon S, Poli-de-Figueiredo CE, Ramachandran R, Sahay M, Samavedam S, Shemies R, Shetty MS, Wiles K, Wium L, Wu VC, Yadla M, Ronco C, Mehta RL, Ostermann M Pregnancy-associated acute kidney injury - consensus report of the 32nd Acute Disease Quality Initiative workgroup Nat Rev Nephrol, 2025.PMID 40681846
[4]Lumlertgul N, Claure-Del Granado R, Acharya A, Ankawi G, Gowrishankar S, Ronco C, Mehta RL, Nelson-Piercy C, Ostermann M Diagnosis, diagnostic approach and challenges in pregnancy-associated AKI-the ADQI 32 consensus meeting Nephrol Dial Transplant, 2026.PMID 41143732
[5]Costantine MM Physiologic and pharmacokinetic changes in pregnancy Front Pharmacol, 2014.PMID 24772083
[6]Chu J, Johnston TA, Geoghegan J Maternal Collapse in Pregnancy and the Puerperium: Green-top Guideline No. 56 BJOG, 2020.PMID 31845507