Abstract: FR-PO0995
Severe Postpartum AKI with Marked Biochemical Derangement and Minimal Biopsy Findings After Nonsteroidal Anti-Inflammatory Drug (NSAID) Exposure
Session Information
- Women's Health and Kidney Diseases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2100 Women's Health and Kidney Diseases
Authors
- Segal, Elnatan, Hadassah University Medical Center, Jerusalem, Jerusalem District, Israel
- Pri Chen, Hadass, Hadassah University Medical Center, Jerusalem, Jerusalem District, Israel
- Eyal, Ophir, Hadassah University Medical Center, Jerusalem, Jerusalem District, Israel
Introduction
Evaluation of AKI in the postpartum period is particularly challenging due to the broad differential diagnosis, including hypertensive disorders, hemorrhagic complications, and infectious etiologies. NSAIDs are also recognized as a potential contributor to renal injury in this setting. Nevertheless, NSAIDs remain widely recommended as first-line agents for postpartum analgesia.
Case Description
We report a previously healthy 34-year-old woman who presented several days after an uncomplicated vaginal delivery with severe acute kidney injury in the setting of substantial NSAID exposure. Serum creatinine increased from 0.6 to 4.5 mg/dL, phosphate peaked at 11.1 mg/dL, and urine albumin-to-creatinine ratio reached 868 mg/g. C-reactive protein rose from 7 to 23 mg/dL and subsequently declined to 6 mg/dL without antimicrobial therapy; blood and urine cultures remained negative throughout hospitalization. Despite extensive evaluation- including routine laboratory testing, comprehensive serologic studies, multimodal imaging, and detailed urinalysis—the differential diagnosis remained broad and inconclusive.
Kidney biopsy revealed only mild acute tubular injury, discordant with the severity of renal dysfunction and biochemical abnormalities. With supportive care alone, the patient demonstrated gradual clinical and biochemical recovery.
Discussion
This case highlights the marked clinicopathologic discordance that may occur in post-partum AKI, underscores the potential contribution of NSAID exposure in the hemodynamically vulnerable post-partum state, and illustrates the critical role of kidney biopsy in guiding management and avoiding unnecessary empiric therapies.