Functional State of the Liver in Patients with Acute Kidney Failure Caused by Blood Loss During Childbirth

Relevance. Acute kidney injury caused by massive postpartum hemorrhage is accompanied by secondary impairment of liver function. Clinical and laboratory parameters (transaminases, bilirubin, prothrombin index, protein metabolism) reflect the severity of hypoxic and toxic liver injury. A direct correlation has been established between the degree of renal dysfunction and changes in hepatic functional status, emphasizing the need for comprehensive monitoring in the postpartum period.

The aim of the study was to assess the incidence, nature, and severity of combined liver damage in postpartum women with acute kidney injury (AKI) of obstetric origin, and to develop approaches for predicting this complication and for differentiated therapy aimed at reducing mortality from acute liver injury (ALI).

Material. and methods. This retrospective study included 22 patients with ALI resulting from obstetric pathology who were treated in the intensive care unit between 2020 and 2024. The mean age of the patients was 28.0±1.8 years. Liver function was assessed using biochemical tests (ALT, AST, LDH and its isoenzymes, bilirubin, prothrombin index), the Bromsulphalein test, as well as evaluation of fractional hepatic blood flow (FHF) by imaging techniques.

Results. Despite satisfactory standard biochemical parameters in most patients, in-depth examination revealed impaired liver function. Analysis of the LDH isoenzyme spectrum showed increased activity of LDH-4 and LDH-5 fractions, indicating hepatocyte cytolysis. The Bromsulphalein test demonstrated impaired detoxification and uptake–excretory function of the liver in 4 out of 5 examined patients. In 2 out of 4 patients, a moderate decrease in fractional hepatic blood flow (FHF) was recorded.

Conclusion. The obtained data indicate that patients with ALI following obstetric hemorrhage often develop combined liver injury, which may not be detected by routine biochemical tests. For early diagnosis and assessment of the severity of liver damage in this category of patients, it is advisable to use methods such as LDH isoenzyme determination and the Bromsulphalein test.

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