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

Abstract

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.

An Evaluation of Cerebral and Systemic Predictors of 18-Month Outcomes for Neonates With Hypoxic Ischemic Encephalopathy

“…The presence of acute kidney injury (AKI) was reported to be a predictor of abnormal brain MRI at 7–10 days of life in asphyxiated newborns (OR 3.2, 95% confidence interval 1.3–8.2) 22 , however, there was no correlation between the stage of AKI and the degree of brain MRI abnormalities. Short-term markers of abnormal neurologic outcome can be imprecise predictors of long-term neurodevelopment.…”

Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

“…That is to say if the SCr rose from 0.1 to 0.2 mg/dL or from 0.1 to 0.4 mg/dL each did not qualify as AKI (SCr was not above 0.5 mg/dL), but if the SCr rose from 0.4 to 0.6 mg/dL or from 0.3 to 0.6 mg/dL this did qualify as AKI (SCr was above 0.5 mg/dL). This was utilized to account for the precision of our assay locally and has been utilized successfully in previous reports [18][19][20] to prevent a bias toward classifying AKI as present in young infants [21]. A modified Jaffe reaction is utilized for SCr measurement at the University of Michigan.…”

A new approach to define acute kidney injury in term newborns with hypoxic ischemic encephalopathy

“…While these patients can be treated with therapeutic hypothermia to minimize brain injury [2, 3], they are also at high risk of developing acute kidney injury (AKI) [4, 5]. Therefore, it is important to identify all newborns with HIE during the early stages of AKI to initiate rapid renal supportive therapy.…”