Renal and cardiovascular repercussions in preeclampsia and their impact on fluid management: a literature review

Abstract

Preeclampsia is a multifactorial condition associated with significant morbidity and mortality. Fluid therapy in these patients is challenging since volume expansion may precipitate pulmonary edema, and fluid restriction may worsen renal function. Furthermore, cardiac impairment may introduce an additional component to the hemodynamic management. This article reviews the repercussions of preeclampsia on renal and cardiovascular systems and the development of pulmonary edema, as well as to discuss fluid management, focusing on the mitigation of adverse outcomes and monitoring alternatives. The literature review was carried out using PubMed, Embase, and Google Scholar databases from May 2019 to March 2020. Papers addressing the subjects of interest were included regardless of the publication language. There is a current trend towards restricting the administration of fluids in women with non-complicated preeclampsia. However, patients with preeclampsia may experience hemorrhagic shock, requiring volume resuscitation. In this case, hemodynamic monitoring is recommended to guide fluid therapy while avoiding complications.

Keywords: Acute kidney injury; Cardiovascular; Fluid management; Preeclampsia; Pulmonary edema; Review article.

Figure 1

Considerations while choosing the fluid management strategy in women with preeclampsia.

Figure 2

Multifactorial etiology of pulmonary edema in preeclampsia.