Diagnosis of Acute Renal Failure in Very Preterm Infants

Abstract

This study was designed to improve the definition of acute renal failure (ARF) in very preterm infants. Twenty-eight newborn infants with gestational age ≤32 weeks were prospectively studied in the first 5 days of life and made up a control group as they did not present risk factors for vasomotor renal insufficiency. Renal insufficiency was defined as an increase in daily serum creatinine concentration above the 99th interval limit obtained in this control group, i.e., 43 µmol/l on day 1 and/or 21 µmol/l on day 2 and/or 14 µmol/l/day on day 3 and/or 22 µmol/l/day on day 4. According to this definition, 20 very preterm infants with ARF were identified. As compared with the control group, the ARF group showed more prolonged oliguric episodes, lower diuresis, insufficient weight loss (in spite of a reduction in water intake) and also more episodes with natremia <130 mEq/l (35 vs. 0%; p < 0.05) and/or kalemia >6 mEq/l (40 vs. 11%; p < 0.05). Therefore, assessment of daily changes in serum creatinine concentration in very preterm infants allows the diagnosis of clinically significant reduction in glomerular filtration rate.

Urinary kidney injury molecule-1 rapid test predicts acute kidney injury in extremely low-birth-weight neonates

“…Those findings were confirmed by similar results of other authors (1,23,24). Choker et al (25) found that neonates with AKI had significantly lower GS and BW than those without AKI.…”

Elevation in plasma creatinine and renal failure in premature neonates without major anomalies: terminology, occurrence and factors associated with increased risk

“…[1][2][3][4][5][6][7][8] This complexity is highlighted by how the terms 'renal dysfunction' and 'renal failure' are used in our data set. Only 15% of infants with any creatinine X1.3 mg per 100 ml and 33% of infants with any creatinine X2.0 mg per 100 ml were identified as having 'renal problems.'…”

“…Some authors have suggested a persistent increase in plasma creatinine concentration >1.5 mg per 100 ml 6,7 but more stringent criteria were proposed by others. 2,8 The assessment of renal function is critical for the adjustment of medication dosing, and in planning fluid, nutritional and electrolyte support. The measurement and interpretation of renal function in premature neonates is complicated by in utero events, maternal drug exposure history, delivery history, gestational age, birth weight, postnatal illness severity, renal development and changing muscle mass.…”

Hypoproteinemia on the first day of life and adverse outcome in very preterm infants admitted to the neonatal intensive care unit

“…Information was collected about antenatal history: maternal age, hypertensive disease of pregnancy, placental diseases (placental abruption, placenta praevia), preterm prelabor rupture of membranes, threatened preterm labor, diabetes, antenatal steroids administration, singleton or multiple pregnancy, clinical chorioamnionitis and mode of delivery. The following data about birth and postnatal diseases were also collected: GA, BW, gender, appropriateness of BW for GA (according to reference Hadlock FP et al 13 ), transfer after birth (outborn), 1 min Apgar score, anemia at birth (venous hemoglobin <13.3 g dl À1 at the admission in NICU), 14 early onset sepsis (EOS), respiratory distress syndrome (RDS) requiring surfactant, acute renal failure, 15 hemodynamically significant patent ductus arteriosus, late onset sepsis, necrotizing enterocolitis and bronchopulmonary dysplasia. The GA in completed weeks was assessed on the basis of the mother's last menstrual period, and confirmed or modified when necessary by routine early antenatal ultrasound examination.…”