Emergency acute kidney injury that occurred during mid-pregnancy due to severe ovarian hyperstimulation syndrome: A case report

Abstract

Ovarian hyperstimulation syndrome (OHSS) is a life-threatening complication of controlled ovarian hyperstimulation (COH) in fertility treatments. Severe OHSS may result in acute kidney injury (AKI) and poor pregnancy outcomes. Although rare, it is potentially fatal, posing a significant challenge for obstetricians, nephrologists, and critical care physicians. Here, we present a 32-year-old female at 22 weeks and 6 days gestation post-COH, hospitalised with nausea, vomiting, fatigue, and AKI. Her clinical course was complicated by haemodynamic instability, characterized by hypotension and oliguria, along with elevated serum creatinine levels, contributing to adverse pregnancy outcomes. She subsequently developed dyspnoea due to chylothorax, enlarged haemorrhagic ovaries, and massive ascites. She was treated with intravenous fluids, albumin, and anticoagulants, resulting in improvement of renal function (serum creatinine: 0.78 mg/dL, reference range 0.52-1.04 mg/dL at discharge). With the increasing use of assisted reproductive technologies, OHSS remains a significant clinical concern. Early diagnosis and multidisciplinary management are essential to mitigate risks.

Keywords: ovarian hyperstimulation syndrome (OHSS); pregnancy; acute kidney injury (AKI); assisted reproductive therapy (ART).