Acute kidney injury in premature and low birth weight neonates: a systematic review and meta-analysis

Wu, Yang; Wang, Haoran; Pei, Jiao; Jiang, Xiaoping; Tang, Jun

doi:10.1007/s00467-021-05251-0

Cited by 26 publications

(24 citation statements)

References 62 publications

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“…The early diagnosis of AKI in preterm newborns is crucial for early initiation of therapy, starting diuretic therapy in oliguric patients, and adjusting medication doses and fluid intake to sustain or achieve the homeostatic balance. That way, we could minimize the long-term consequences of AKI (13,14). With that goal, the difficulties with timely diagnosis of AKI are trying to be solved with new biomarkers of AKI.…”

Section: O N L I N E F I R S Tmentioning

confidence: 99%

Early detection of acute kidney injury in preterm newborns with perinatal asphyxia using serum cystatin

Hadžimuratović¹,

Hadžimuratović²,

Pokrajac³

et al. 2023

Sanamed

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Introduction:The diagnosis of acute kidney injury (AKI) in preterm newborns with perinatal asphyxia based on increased serum creatinine (sCr) value and oliguria/anuria is usually delayed. The Aim of this paper is to evaluate serum cystatin C as an early predictor of AKI. Materials and methods:The study included 42 preterm newborns (24-37 weeks) with perinatal asphyxia (Apgar score (AS) ≤ 3 at 5 minutes of life or blood pH on admission ≤ 7.00). The sCr and sCysC levels were measured on the 1st, 3rd, and 7th day of life. According to KDIGO criteria, the newborns were classified into groups, and sCr and sCys-C values were compared. Results:The mean gestational age was 29.9 ± 3.0 weeks. AKI was diagnosed in 62.8 % of patients. Of these patients, 81.5% belonged to AKI 1 group, and 18.5 % to AKI 2 group.No newborns had the criteria for AKI 3. On day 7 the mean sCr values were significantly higher in AKI (65.4± 21.8) compared with the non-AKI group (168.4±38.2) (p<0.001), but not on day 1 and 3 (p = 0.322, 0.012, respectively). The sCys-C values were significantly higher in the AKI group on day 3 ( AKI vs. non-AKI group, 0.69 ±0.22 vs. 1.22 ±0.20; p <0.001) and day 7 (AKI vs. non-AKI group, 0.62 ±0.41 vs. 1.68 ±0.20; p <0.001). The sCys-C was also an earlier marker of a more severe stage of AKI than sCr. Conclusion:The sCys-C was elevated earlier than sCr, making it a valuable diagnostic tool for AKI in preterm newborns.

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Section: O N L I N E F I R S Tmentioning

confidence: 99%

Early detection of acute kidney injury in preterm newborns with perinatal asphyxia using serum cystatin

Hadžimuratović¹,

Hadžimuratović²,

Pokrajac³

et al. 2023

Sanamed

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“…In this study the incidence of AKI was 38% and differed significantly by GA, with AKI rates being significantly higher with decreasing GA and BW. In 2021, Wu et al published a meta-analysis of 50 articles including over 10,000 premature and LBW neonates evaluating the incidence and impact of neonatal AKI ( 21 ). This study showed a pooled incidence of AKI of 25% (95% CI 20–30%), and those with AKI had significantly higher odds of mortality (OR 7.1; 95% CI 5.9–8.6; p < 0.01).…”

Section: Epidemiology Risk Factors and Outcomes Of Neonatal Akimentioning

confidence: 99%

Neonatal Acute Kidney Injury

et al. 2022

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Acute kidney injury (AKI) is a common occurrence in the neonatal intensive care unit (NICU). In recent years, our knowledge of the incidence and impact of neonatal AKI on outcomes has expanded exponentially. Neonatal AKI has been shown to be associated with adverse outcomes including increased length of mechanical ventilation, prolonged length of stay, and rise in mortality. There has also been increasing work suggesting that neonates with AKI are at higher risk of chronic kidney disease (CKD). In the past, AKI had been defined multiple ways. The utilization of the neonatal modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria as the standard definition for neonatal AKI in research and clinical care has driven the advances in our understanding of neonatal AKI over the last 10 years. This definition has allowed researchers and clinicians to better understand the incidence, risk factors, and outcomes associated with neonatal AKI across populations through a multitude of single-center studies and the seminal, multicenter Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study. As the impacts of neonatal AKI have become clear, a shift in efforts toward identifying those at highest risk, protocolizing AKI surveillance, improving prevention and diagnosis, and expanding kidney support therapy (KST) for neonates has occurred. These efforts also include improving risk stratification (identifying high risk populations, including those with nephrotoxic medication exposure) and diagnostics (novel biomarkers and diagnostic tools). Recent work has also shown that the targeted use of methylxanthines may prevent AKI in a variety of high-risk populations. One of the most exciting developments in neonatal AKI is the advancement in technology to provide KST to neonates with severe AKI. In this comprehensive review we will provide an overview of recent work and advances in the field of neonatal AKI. This will include a detailed review of (1) the definition of neonatal AKI, (2) the epidemiology, risk factors, and outcomes associated with neonatal AKI, (3) improvements in risk stratification and diagnostics, (4) mitigation and treatment, (5) advancements in the provision of KST to neonates, and (6) the incidence and risk of subsequent CKD.

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“…One attractive future direction on which this technique may shed light, is that of neonatal and specifically preterm AKI. AKI prevalence in the neonatal intensive care unit (NICU) is extremely high and is associated with high mortality rates [49][50][51]. Advancements in modern medicine have resulted in increased survival of extreme preterm infants (<28 weeks of gestation) who are born with lower nephron endowment and consequently lower kidney reserve.…”

Section: Potential Role Of Gene Editing In Human Kidney Organoids And...mentioning

confidence: 99%

“…Advancements in modern medicine have resulted in increased survival of extreme preterm infants (<28 weeks of gestation) who are born with lower nephron endowment and consequently lower kidney reserve. These baseline characteristics combined with common cardiovascular abnormalities (e.g., Patent Ductus Arteriosus), high exposure to nephrotoxic medications, and poor nutrition, greatly increase their renal vulnerability and consequently their risk for development of AKI, estimated to be as high as 25-48% in recent cohorts [49][50][51][52][53][54]. iPSC-derived kidney organoids, which can reach a degree of maturation equivalent to kidneys at the second trimester of human gestation, in congruence with cell specific CRISPR/Cas induced reporters, offer a unique window into the specific effects of insults to the developing human kidney and may reveal potential personalized targets for therapeutic intervention and kidney regeneration in this highly vulnerable patient population.…”

Section: Potential Role Of Gene Editing In Human Kidney Organoids And...mentioning

confidence: 99%

Human Stem Cell and Organoid Models to Advance Acute Kidney Injury Diagnostics and Therapeutics

Pode‐Shakked

Devarajan

2022

IJMS

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Acute kidney injury (AKI) is an increasingly common problem afflicting all ages, occurring in over 20% of non-critically ill hospitalized patients and >30% of children and >50% of adults in critical care units. AKI is associated with serious short-term and long-term consequences, and current therapeutic options are unsatisfactory. Large gaps remain in our understanding of human AKI pathobiology, which have hindered the discovery of novel diagnostics and therapeutics. Although animal models of AKI have been extensively studied, these differ significantly from human AKI in terms of molecular and cellular responses. In addition, animal models suffer from interspecies differences, high costs and ethical considerations. Static two-dimensional cell culture models of AKI also have limited utility since they have focused almost exclusively on hypoxic or cytotoxic injury to proximal tubules alone. An optimal AKI model would encompass several of the diverse specific cell types in the kidney that could be targets of injury. Second, it would resemble the human physiological milieu as closely as possible. Third, it would yield sensitive and measurable readouts that are directly applicable to the human condition. In this regard, the past two decades have seen a dramatic shift towards newer personalized human-based models to study human AKI. In this review, we provide recent developments using human stem cells, organoids, and in silico approaches to advance personalized AKI diagnostics and therapeutics.

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Acute kidney injury in premature and low birth weight neonates: a systematic review and meta-analysis

Cited by 26 publications

References 62 publications

Early detection of acute kidney injury in preterm newborns with perinatal asphyxia using serum cystatin

Early detection of acute kidney injury in preterm newborns with perinatal asphyxia using serum cystatin

Neonatal Acute Kidney Injury

Human Stem Cell and Organoid Models to Advance Acute Kidney Injury Diagnostics and Therapeutics

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