A new approach to define acute kidney injury in term newborns with hypoxic ischemic encephalopathy

Abstract

Background Current definitions of acute kidney injury (AKI) are not sufficiently sensitive to identify all newborns with AKI during the first week of life. Methods To determine whether the rate of decline of serum creatinine (SCr) during the first week of life can be used to identify newborns with AKI, we reviewed the medical records of 106 term neonates at risk of AKI who were treated with hypothermia for hypoxic ischemic encephalopathy (HIE). Results Of the newborns enrolled in the study, 69 % showed a normal rate of decline of SCr to ≥50 % and/or reached SCr levels of ≤0.6 mg/dl before the 7th day of life, and therefore had an excellent clinical outcome (control group). Thirteen newborns with HIE (12 %) developed AKI according to an established neonatal definition (AKI–KIDGO group), and an additional 20 newborns (19 %) showed a rate of decline of SCr of <33, <40, and <46 % from birth to days 3, 5, or 7 of life, respectively (delayed rise in estimated SCr clearance group). Compared to the control group, newborns in the other two groups required more days of mechanical ventilation and vasopressor drugs and had higher gentamicin levels, more fluid overload, lower urinary epidermal growth factor levels, and a prolonged length of stay. Conclusions The rate of decline of SCr provides a sensitive approach to identify term newborns with AKI during the first week of life.

Acute Kidney Injury Urine Biomarkers in Very Low-Birth-Weight Infants

“…SCr was measured once in four of 113 (3.5%), twice in six of 113 (5.3%), three times in ten of 113 (8.8%), and at least four times in 93 of 113 (82%) of the cohort during the 2 weeks of life (median, 5 [range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14] days). Neonatal AKI was defined using the Kidney Disease Improving Global Outcomes AKI definition, in which stage 1 was defined as an increase of SCr $ 0.3 mg/dl or Figure 1.…”

“…Prior literature has shown that in premature infants without AKI, urine proteins will be highest among those with the lowest GA, probably because of the passive loss of proteins in the context of immature tubular function (6)(7)(8). Previously, we (7) and others (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) have published data on the ability of urine biomarkers to predict AKI in neonates; however, these studies are limited by the size of the cohort or the use of nested case-control methods, with most of these studies evaluating only one biomarker. In addition, previous studies were subject to risk of misclassification bias, given that many infants had only a few SCr levels measured to determine AKI.…”

Somatic dysfunctions of newborns with аsphyxia after systemic herapeutic hypothermia

“…Частота ураження нирок при перинатальній асфіксіі становить 65-70%. Зни жена перфузія ниркових судин особливо пошкоджує проксимальні канальні [10,14] та веде до розвитку гострого тубулярного некрозу, і як наслідок, до гострої ниркової недостатності [22]. Такі патологічні прояви підвищують ризик патології нирок і в подаль шому житті [2,3].…”

Cardiovascular Alterations and Multiorgan Dysfunction After Birth Asphyxia

“…Serum creatinine will not begin to rise until 25 to 50% of renal function is lost, thus significant injury can occur without changes in creatinine [92]. The change in serum creatinine levels over the first few days is predictive of renal injury, with normal values of >50% decline or serum creatinine <0.6 is found in 70% of infants after HIE [93]. A fractional excretion of sodium of greater than 3% is moderately specific after 48 hours for AKI [84].…”

“…A fractional excretion of sodium of greater than 3% is moderately specific after 48 hours for AKI [84]. Although Cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) are both specific markers of other pediatric kidney injury, they can be elevated by birth asphyxia and unable to determine whether an infant will develop AKI [93, 94]. A recent study demonstrated a NGAL level greater than 250 ng/ml was significantly associated with severe HIE and mortality [95].…”