Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Narrative Review

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

Repercussões Renais e Cardiovasculares na Pré-Eclâmpsia e Seu Impacto no Gerenciamento de Fluidos: Uma Revisão da Literatura

Wallace Andrino da Silva, Aline Macedo Pinheiro, Paulo Henrique Lima, Luiz Marcelo S. Malbouisson

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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.


Review article,  Preeclampsia,  Acute kidney injury,  Cardiovascular,  Pulmonary edema,  Fluid management


A pré-eclâmpsia é uma condição multifatorial associada a significativa morbimortalidade. A fluidoterapia nesses pacientes é um desafio, pois a expansão do volume pode precipitar edema pulmonar e a restrição de líquidos pode piorar a função renal. Além disso, o comprometimento cardíaco pode introduzir um componente adicional ao manejo hemodinâmico. Este artigo revisa as repercussões da pré-eclâmpsia nos sistemas renal e cardiovascular e no desenvolvimento de edema pulmonar, assim como discute o controle de fluidos, com ênfase na mitigação de desfechos adversos e alternativas de monitoramento. A revisão da literatura foi realizada nas bases de dados PubMed, Embase e Google Scholar de maio de 2019 a março de 2020. Os artigos que abordavam os assuntos de interesse foram incluídos independentemente do idioma de publicação. Existe uma tendência atual de restringir a administração de fluidos em mulheres com pré-eclâmpsia não complicada. No entanto, pacientes com pré-eclâmpsia podem apresentar choque hemorrágico, exigindo ressuscitação com volume. Nesse caso, a monitorização hemodinâmica é recomendada para orientar a fluidoterapia e evitar complicações.


Artigo de revisão; Pré-eclâmpsia; Lesão renal aguda; Cardiovascular; Edema pulmonar; Controle de fluidos


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