Management of acute renal failure in newborns

Jb, Gouyon; Guignard, Jean‐Pierre

doi:10.1007/s004670050068

Cited by 154 publications

(145 citation statements)

References 27 publications

(51 reference statements)

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“…These findings are consistent with the current knowledge that various clinical conditions occurring in NICU may impair neonatal renal function: Creatinine changes in preterm infants S Iacobelli et al RDS, mechanical ventilation, systemic hemodynamic compromise, acute anemia, dehydration, hypoxemia, acidosis and nephrotoxic drugs including ibuprofen. 22 We have also found that in infants with hsPDA, SeCr increase preceded ibuprofen administration, this suggesting that a renal impairment because of PDA and/or associated conditions exists before starting NSAID therapy. Concerning this point, many studies demonstrated that prophylactic or therapeutic ibuprofen, as with other cyclooxygenase inhibitors, may not be exempt from causing renal adverse effects, [23][24][25] but few investigations have explored the effect on renal function of PDA before and independently from ibuprofen treatment.…”

Section: Discussionmentioning

confidence: 54%

Factors affecting postnatal changes in serum creatinine in preterm infants with gestational age <32 weeks

et al. 2008

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Section: Discussionmentioning

confidence: 54%

Factors affecting postnatal changes in serum creatinine in preterm infants with gestational age <32 weeks

et al. 2008

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“…The large extracorporeal circuit volumes, anticoagulation, and vascular access required are limiting factors, particularly in neonates. As a result, peritoneal dialysis (PD) is generally the most common form of RRT in young children, including neonates, the advantages being relative ease of access and technical simplicity (6,7). Acute PD can easily be performed in units with no HD expertise, and it is effective for the management of AKI and metabolic disturbances in children of all ages, including newborns and preterm infants (8).…”

mentioning

confidence: 99%

Acute Peritoneal Dialysis in Neonates with Acute Kidney Injury and Hypernatremic Dehydration

Yıldız¹,

Ergüven²,

Yıldız³

et al. 2012

Perit Dial Int

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♦ Objective: We aimed to evaluate the efficacy of acute peritoneal dialysis (PD) and clinical outcomes in neonates with acute kidney injury (AKI) and hypernatremic dehydration. ♦ Methods: The medical records of 15 neonates with AKI and hypernatremic dehydration who were treated with acute PD were reviewed. The diagnoses were AKI with hypernatremic dehydration with or without sepsis in 13 patients and AKI with hypernatremia and congenital nephropathy in 2 patients. The main indications for PD were AKI with some combination of oligoanuria, azotemia, hyperuricemia, and metabolic acidosis unresponsive to initial intensive medical treatment. ♦ Results: The mean age of the patients at dialysis initiation was 11.9 ± 9 days, and the mean duration of PD was 6.36 ± 4.8 days. In 7 patients (46.7%), hypotension required the use of vasopressors, and in 6 patients (40%), mechanical ventilation was required. Peritoneal dialysisrelated complications occurred in 7 patients (46.7%), the most common being catheter malfunction (n = 6). Four episodes of peritonitis occurred in the 15 patients (26.7%), 2 episodes in patients with congenital renal disease and 2 episodes in patients with sepsis and multiorgan failure, who did not survive. Congenital renal disease, septicemia, and the need for mechanical ventilation were important factors influencing patient survival. All patients with no pre-existing renal disease or sepsis recovered their renal function and survived. ♦ Conclusions: In neonates with AKI and hypernatremic dehydration, PD is safe and successful, and in patients without congenital renal disease or sepsis, the prognosis is good. Peritoneal dialysis should be the treatment of choice in neonates with AKI and hypernatremic dehydration who do not respond to appropriate med ical treatment. A cute kidney injury (AKI) in neonates has many causative factors. Hypernatremic dehydration associated with breastfeeding is one such cause. Although successful breastfeeding provides compelling advantages to infants and mothers, inadequate breastfeeding may result in lifethreatening dehydration. Hypernatremic dehydration is a rare complication of breastfeeding (1,2), but recent reports have shown that its incidence is increasing (2-5). Prolonged hypovolemia and decreased renal perfusion can cause intrinsic renal injury.Once intrinsic renal failure becomes established, treatment of the metabolic complications of AKI involves appropriate management of fluid, electrolytes, and acidbase balance; provision of good nutrition; and initiation of renal replacement therapy (RRT) if conventional therapy fails to control metabolic complications and fluid overload (6). The preferential use of hemodialysis (HD) and hemofiltration by pediatric nephrologists is increasing, but those modalities are technically difficult procedures. The large extracorporeal circuit volumes, anticoagulation, and vascular access required are limiting factors, particularly in neonates. As a result, peritoneal dialysis (PD) is generally the most common form of RRT in young child...

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“…The reported incidence of neonatal AKI ranges from 6% to 24% (2,5). A recent, single-center study reported a 10-y incidence of renal failure in Ͻ1000 g infants of 5.5%.…”

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confidence: 99%

Urinary NGAL in Premature Infants

et al. 2008

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Premature infants are at unique risk for developing acute kidney injury (AKI) due to incomplete nephrogenesis, early exposure to nephrotoxic medications, and coexisting conditions such as patent ductus arteriosus (PDA) and respiratory distress syndrome (RDS). Unfortunately, laboratory testing for the diagnosis of AKI in this population is problematic because of the physiology of both the placenta and the extra-uterine premature kidney. Recent research has led to the development of promising biomarkers for the early detection of AKI in children but there are no published reports in neonates. Our goal was to determine whether urine neutrophil gelatinaseassociated lipocalin (NGAL) was detectable in premature infants and to correlate levels with gestational age, birth weight (BW), or indomethacin exposure. We enrolled 20 infants in four BW groups: 500 -750, 751-1000, 1001-1250, and 1251-1500 g. Urine was collected every day for the first 14 d of life. Neonates born at earlier gestational ages and lower BWs had higher urine NGAL levels (p Ͻ 0.01). We conclude that urine NGAL is easily obtained in premature infants and that it correlates significantly with both BW and gestational age. The use of urinary NGAL as a biomarker of AKI in premature infants warrants further investigation. (Pediatr Res 64: [423][424][425][426][427][428] 2008)

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Management of acute renal failure in newborns

Cited by 154 publications

References 27 publications

Factors affecting postnatal changes in serum creatinine in preterm infants with gestational age <32 weeks

Factors affecting postnatal changes in serum creatinine in preterm infants with gestational age <32 weeks

Acute Peritoneal Dialysis in Neonates with Acute Kidney Injury and Hypernatremic Dehydration

Urinary NGAL in Premature Infants

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