Evaluation of glomerular and tubular renal function in neonates with birth asphyxia

Kaur, Satinder; Jain, Sumeet; Saha, Abhijeet; Chawla, Deepak; Parmar, Veena R.; Basu, Shreerupa; Kaur, Jasmeen

doi:10.1179/146532811x12925735813922

Cited by 86 publications

(73 citation statements)

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“…Postulated mechanisms for hypothermic neuroprotection are nonspecific and, in theory, the beneficial effect of hypothermia should extend beyond the brain to include other organs commonly affected during a hypoxic-ischemic insult, including kidneys. Interestingly, the 39% incidence of AKI in our cohort that underwent therapeutic hypothermia was similar to that reported by Kaur et al (6), also using the Acute Kidney Injury Network criteria in asphyxiated infants who did not receive therapeutic hypothermia. There were some important differences between the definitions used in these studies.…”

Section: Kidney Injury Brain Mri and Coolingsupporting

confidence: 88%

“…The importance and prognostic significance of AKI in the neonatal period is becoming increasingly apparent (6,11,16,17). Using contemporary categorical SCr-based definitions, we report for the first time that AKI is associated with Values are mean ± seM.…”

Section: Discussionmentioning

confidence: 99%

“…a cute kidney injury (AKI) is common in neonates suffering from perinatal asphyxia (1)(2)(3)(4)(5)(6). Before the advent of therapeutic hypothermia, studies evaluating the relationship of renal and central nervous system injury in asphyxiated newborns reported acute renal failure to be significantly associated with worsening hypoxic-ischemic encephalopathy (HIE), and adverse long-term neurodevelopmental outcome (5,7,8).…”

mentioning

confidence: 99%

“…This and similar definitions have gained acceptance as a way to define AKI in newborns (9,10). A similar definition was used to study AKI in neonates with perinatal asphyxia not receiving therapeutic hypothermia (6) and recently by our group in neonates treated with therapeutic hypothermia for perinatal asphyxia (11). To date, the correlation between AKI and severity of hypoxicischemic injury on brain magnetic resonance imaging (MRI) has not been evaluated in neonates treated with therapeutic hypothermia.…”

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confidence: 99%

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Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

et al. 2013

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Background:We hypothesized that acute kidney injury (AKI) in asphyxiated neonates treated with therapeutic hypothermia would be associated with hypoxic-ischemic lesions on brain magnetic resonance imaging (MRI). Methods: Medical records of 88 cooled neonates who had had brain MRI were reviewed. All neonates had serum creatinine assessed before the start of cooling; at 24, 48, and 72 h through cooling; and then on day 5 or 7 of life. A neonatal modification of the Kidney Disease: Improving Global Outcomes guidelines was used to classify AKI. MRI images were evaluated by a neuroradiologist masked to outcomes. Outcome of interest was abnormal brain MRI at 7-10 d of life. results: AKI was found in 34 (39%) of 88 neonates, with 15, 7, and 12 fulfilling criteria for stages 1, 2, and 3, respectively. Brain MRI abnormalities related to hypoxia-ischemia were present in 50 (59%) newborns. Abnormal MRI was more frequent in infants from the AKI group (AKI: 25 of 34, 73% vs. no AKI: 25 of 54, 46%; P = 0.012; odds ratio (OR) = 3.2; 95% confidence interval (CI) = 1.3-8.2). Multivariate analysis identified AKI (OR = 2.9; 95% CI = 1.1-7.6) to be independently associated with the primary outcome. conclusion: AKI is independently associated with the presence of hypoxic-ischemic lesions on postcooling brain MRI.

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Section: Kidney Injury Brain Mri and Coolingsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

et al. 2013

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“…The findings of single-center prospective studies in very low birth weight (VLBW) infants [1], infants who undergo cardiopulmonary bypass [2,3], infants requiring extracorporal pulmonary oxygenation [4,5], and infants with perinatal birth asphyxia [6] suggest that neonatal AKI is common and associated with poor outcomes [7,8]. To define AKI, these studies have used serum creatinine (SCr) alone, or SCr and urine output criteria.…”

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confidence: 99%

Are we ready for the clinical use of novel acute kidney injury biomarkers?

Askenazi

2012

Pediatr Nephrol

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Acute kidney injury (AKI) is a common event in several neonatal populations, and those neonates with AKI have poor outcomes. Serum creatinine (SCr)-based definitions of AKI are not ideal and are additionally limited in neonates whose SCr reflects the maternal creatinine level at birth and normally drops over the first weeks of life dependent on gestational age. Recent studies show that urine and serum biomarkers may provide a better basis than SCr on which to diagnose AKI. In this month's issue of Pediatric Nephrology, Sarafidis et al. show that urine neutrophil gelatinase-associated lipocalin (uNGAL), serum NGAL (sNGAL), and urine cystatin c (uCysC) are highest in those neonates with asphyxia who have elevated SCr. Furthermore, those with asphyxia without a concomitant rise in SCr levels have elevated levels of biomarkers compared to controls, suggesting a dose response. Once the SCr level returns to normal, the levels of novel AKI biomarkers continue to be elevated. While these findings strengthen the argument for the clinical use of these AKI biomarkers, further work is needed before they can be implemented in clinical practice. Large-scale observational multi-center studies are needed to test these biomarkers against hard clinical endpoints. In addition, randomized intervention trials which use biomarkers to define AKI need to be performed.Keywords Acute kidney injury . Ngal . Cystatin c . Asphyxia . Newborn . NeonatesOver the last few years our understanding of the incidence and outcomes in neonates who have acute kidney injury (AKI) has improved. The findings of single-center prospective studies in very low birth weight (VLBW) infants [1], infants who undergo cardiopulmonary bypass [2,3], infants requiring extracorporal pulmonary oxygenation [4,5], and infants with perinatal birth asphyxia [6] suggest that neonatal AKI is common and associated with poor outcomes [7,8]. To define AKI, these studies have used serum creatinine (SCr) alone, or SCr and urine output criteria. Although SCr is currently the most available method to define AKI, SCrbased AKI definitions are not ideal for numerous reasons. Firstly, because SCr is a measure of function (not injury), it is a late biomarker for an acute injury. Secondly, due to renal function reserve, more than 50 % of nephrons must be compromised before changes in SCr level are evident. Therefore, SCr is at best a late marker of significant renal dysfunction. In neonates, SCr-based AKI definitions are additionally complicated because at birth SCr reflects maternal creatinine, which improves over the first few weeks of life, dependent on gestational age [9]. For these and other reasons, newer definitions of a neonatal AKI using noninvasive serum and urine biomarkers are greatly needed.Studies in VLBW infants [10,11], infants who undergo cardiopulmonary bypass surgery [3,[12][13][14][15][16][17], and other sick newborns admitted to a neonatal intensive care unit [18] suggest that such biomarkers can detect those infants who will later have a rise in SCr and that...

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Frequency of Acute Kidney Injury and Association With Mortality Among Extremely Preterm Infants

et al. 2022

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ImportanceNeonatal acute kidney injury (AKI) is common and associated with morbidity and mortality. The temporal relationship between AKI and critical illness, as well as the frequency of AKI definition components (urine output and serum creatinine [sCr] concentration change), are unknown in extremely low-birth-weight (ELBW) (&lt;1000 g), extremely preterm (&lt;29 weeks’ completed gestational age [GA]) infants.ObjectiveTo measure the frequency of AKI from birth to death or discharge with attention to the definition components as well as the temporal relationship of AKI to critical illness and death.Design, Setting, and ParticipantsA single-center, multiyear, retrospective cohort study was conducted at an academic level IV neonatal intensive care unit between January 1, 2012, and January 1, 2020. Participants included inborn ELBW and infants at 22 to 28 weeks’ completed GA with confirmed congenital anomalies who survived 12 hours or more.ExposuresExtremely preterm birth and ELBW.Main Outcomes and MeasuresThe primary outcome was AKI frequency. The timing, severity, and criteria for AKI were measured. The temporal relationship between AKI, organ dysfunction, and outcomes were quantified using odds ratios (ORs), logistic regression, and Shapley Additive Explanations. Acute kidney injury recognition, imaging, pediatric nephrology consultation, and follow-up were determined.ResultsA total of 436 infants (52% male; 44% Black) met the inclusion criteria (median BW, 725 g; median GA, 25.7 wk). Acute kidney injury was common in the first week of life (44%), primarily based on the change in the sCr concentration criterion (88%), and negatively associated with GA (OR, 0.69; 95% CI, 0.60-0.78), but positively associated with antecedent critical illness (OR, 1.17; 95% CI, 1.12-1.23), severe intraventricular hemorrhage (OR, 1.86; 95% CI, 1.12-3.08), late-onset sepsis (OR, 1.03; 95% CI, 1.02-1.03), and mortality (OR, 2.77; 95% CI, 1.63-4.72). Acute kidney injury had negligible clinical contribution to death within the model (Shapley Additive Explanation, &lt;0.5% change to outcome) relative to antecedent patient-concentration organ dysfunction (6%-15% change). Among infants with severe AKI, recognition (32%), nephrology inpatient consultation (16%), and outpatient follow-up (9%) were not common.Conclusions and RelevanceIn this cohort study of ELBW infants, AKI was common in the first week of life, inversely associated with GA, and followed organ (primarily cardiovascular) dysfunction. Acute kidney injury considered as the primary pathway to mortality was rare, and amelioration of AKI to modify death was not well supported.

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Evaluation of glomerular and tubular renal function in neonates with birth asphyxia

Abstract: It is feasible to use AKIN staging for evaluating AKI in neonates with birth asphyxia.

Cited by 86 publications

References 17 publications

Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

Are we ready for the clinical use of novel acute kidney injury biomarkers?

Frequency of Acute Kidney Injury and Association With Mortality Among Extremely Preterm Infants

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