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Kidney Week

Abstract: PO2604

Hyperemesis Gravidarum-Induced Acute Tubular Necrosis: A Case with More Than Fivefold Rise in Serum Lipase Level Above the Upper Limit of Normal

Session Information

Category: Trainee Case Report

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Chandra, Samira Zannat, Dhaka Medical College and Hospital, Dhaka, Bangladesh
  • Taveras Garcia, Bruna, Jacobi Medical Center, Bronx, New York, United States
  • Jim, Belinda, Jacobi Medical Center, Bronx, New York, United States
Introduction

Hyperemesis gravidarum (HG) occurs in 0.3 to 10 percent of pregnancies with only 0.8 percent requiring hospitalization. HG usually starts within 4th to 6th week of gestation, peaks around 9th week and fades away between 16th to 20th gestational weeks. In some cases, HG may last until the third trimester. Here we are reporting such a case which was associated with serious complication like acute renal failure. Co-incidentally the patient was also found to have serum lipase level 5 times above the upper limit of normal (ULN). Since HG exerts multisystemic manifestations, the unusual pattern of raised serum lipase is often due to associated renal impairment.

Case Description

A 25-year old primigravida at 16th week of gestation was admitted for severe dehydration and acute kidney injury (S. Creatinine 5.1 mg/dl). She was suffering from HG since the beginning of her pregnancy. A month prior to this admission, the patient was hospitalized on multiple occasions for extreme nausea and blood-tinted vomiting. Her initial labs were suggestive of high anion gap metabolic acidosis (anion gap 31.9mmol/L). Urine electrolytes (Na+<20mEq/day, K+ 29mEq/day, Cl- <20mEq/day) with FeNa+<0.1% indicated pre-renal etiology and urine microscopy showed muddy brown casts suggestive of ATN. Patient’s serum ALT (134 IU/L) and AST (93 IU/L) were raised >3 and >2 folds of ULN respectively whereas serum lipase (921 U/L) and amylase (309 U/L) levels were raised >5 and 3 folds of ULN respectively. Patient was treated conservatively with IV 0.9% NaCl saline. Eventually, her serum AST, ALT, lipase and amylase started decreasing with spontaneous recovery of renal function overtime (S. Creatinine 0.5mg/dl). Patient's HG persisted until 32nd week of gestation when symptom subsided completely without medication.

Discussion

In acute pancreatitis, the sensitivity and specificity of serum lipase above 3-times of the ULN range 64%-100% and 99%-100% respectively. More than 3-folds rise of serum lipase above the ULN can also be seen in a variety of other conditions including renal failure. Even in 15% cases of HG with normal renal function, serum Lipase can rise by 5-folds. Therefore, clinical and biochemical co-relation is necessary to rule out acute pancreatitis in pregnancy.