Nonoliguric and oliguric acute renal failure in asphyxiated term neonates

Abstract

The purpose of this study was to determine the prevalence and types of acute renal failure in asphyxiated full-term neonates and to evaluate the accuracy of an asphyxia morbidity score in predicting acute renal failure. Neonates admitted to one institution from 1990 through 1993 with a gestational age > or = 36 weeks and 5-min Apgar score < or = 6, without congenital malformations or sepsis, were studied retrospectively for acute renal failure in the 1st week of life. Acute renal failure was defined as serum creatinine > 1.5 mg/dl (133 mumol/l) with normal maternal renal function. Nonoliguric renal failure was defined as renal failure with urine output > 1 ml/kg per hour after the 1st day. An asphyxia morbidity scoring system was used to distinguish severe from moderate asphyxia. The score ranged from 0 to 9 and was based upon fetal heart rate, Apgar score at 5 min, and base deficit in the 1st h of life. The score for severe asphyxia was defined as 6-9 and for moderate asphyxia as 1-5. Sixty-six neonates fulfilled study criteria. Acute renal failure was present in 20 of 33 (61%) infants with severe asphyxia scores and 0 of 33 with moderate asphyxia scores (P < 0.0001). Acute renal failure was nonoliguric in 12 of 20 (60%), oliguric in 5 of 20 (25%) and anuric in 3 of 20 (15%). In conclusion 1) acute renal failure occurred in 61% of infants with severe asphyxia, 2) acute renal failure associated with severe asphyxia was predominantly nonoliguric and 3) an asphyxia morbidity score, which can be determined at 1 h of age, predicted acute renal failure in full-term infants with 100% sensitivity and 72% specificity.

Prevalence and outcomes of acute kidney injury in term neonates with perinatal asphyxia

“…(1) There is a high incidence of AKI among the asphyxiated term infants, (50 -72%). (2,3). The presence of perinatal asphyxia and its severity appear to correlate with increasing incidence of AKI.…”

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

“…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).…”

Role of pRIFLE and AKIN Criteria for Diagnosis of Neonatal Acute Kidney Injury in a Special Care Baby Unit (SCABU)

“…The neonate of d" 7 days old comprised the main bulk.More than two third (68.2)% of the neonates experienced perinatal asphyxia stage II and stage III, most commonest prerenal cause of AKI 18 . Moreover second risk group is septicemia (59%) .…”