Case of iatrogenic neonatal acute kidney injury requiring dialysis and review of literature

Abstract

A full-term male baby was administered furosemide and enalapril for treatment of cardiac failure secondary to a ventricular septal defect. He also received piperacillin-tazobactam and amikacin for 7 days for suspected early-onset neonatal sepsis. He developed anuria and raised creatinine and was referred with acute kidney injury (AKI)—neonatal KDIGO (Kidney Disease Improving Global Outcomes) stage 3 on day 20. Urine output and renal parameters improved after discontinuing drugs and peritoneal dialysis. This case report highlights the importance of serial monitoring of kidney function tests while using nephrotoxic drugs and ensuring correct dosage and titration. In the early stages, AKI can be treated with conservative therapy but once established, renal replacement therapy might be required. It can also lead to chronic kidney disease.

A Systematic Review of Pediatric Dialysis in Asia: Unveiling Demographic Trends, Clinical Representation, and Outcomes

“…Overall, the case studies show a fairly even gender split, with some acute illnesses, like AKI in neonates, having a slight male predominance [17]. On the other hand, females tend to be more affected by childhoodonset lupus nephritis [15].…”

“…Chinese [15,19], Indonesian [16,20], Kazakh [21], Turkish [14,18], Japanese [22], Qatari [23], Nepalese [24], Indian [25,17], and Bangladeshi [26,27] pediatric patients are all included in the dataset. This range emphasizes how important it is to have culturally and regionally appropriate medical procedures.…”

“…The results of laboratory tests played a critical role in the diagnosis and evaluation of disease severity. Elevated blood creatinine and hypoalbuminemia are common symptoms in cases of acute kidney injury (AKI) and nephrotic syndrome [17,19]. Serum creatine kinase (CK) values in a patient with the LPIN1 gene deficiency [18] were remarkably elevated, reaching 943,452 IU/L.…”

“…Increased BUN/creatinine, metabolic acidosis, hyperkalemia, hyperuricemia, immature proximal tubules [14] Assessment of eGFR for CKD progression [15] Elevated liver enzymes pre and post-antiviral treatment [16] High serum creatinine levels [17] Extremely high CK, AST, ALT levels; myoglobinuria [18] Proteinuria, hypoalbuminemia, hypercholesterolemia, reduced GFR Hyperleukocytosis, high CRP and procalcitonin, elevated liver enzymes [21] High CRP, ESR, IL-6, altered hemoglobulin and immunoglobulins [22] Recurrent peritonitis, worsening anemia [23] Anemia, thrombocytopenia, leukocytosis, varied electrolyte imbalance [24] Elevated liver enzymes, high serum creatinine and urea, metabolic acidosis, high formic acid [25] Hypercholesterolemia, hypoalbuminemia, nephrotic range proteinuria [26] Decreased urine output as per pRIFLE criteria, various stages of AKI [27]…”

“…Diverse pathologies and early intervention: Early dialysis intervention is crucial due to the variety of renal diseases that affect children, ranging from congenital abnormalities like renal tubular dysgenesis (RTD) [14] to acute kidney injury (AKI) in infants linked to sepsis and male gender [17]. These investigations emphasize the necessity of early and efficient intervention for a range of pediatric kidney disorders.…”