The main etiologies of acute Kidney injury in the newborns hospitalized in the neonatal intensive care unit

Abstract

Introduction:Acute kidney injury (AKI) is one of the most common diseases among the newborns hospitalized in the neonatal intensive care units (NICUs), which is usually resulted from predisposing factors including sepsis, hypovolemia, asphyxia, respiratory distress syndrome (RDS), and heart failure. The goal of this study was to assess main etiologies, relevant risk factors, and early outcome of neonatal AKI.Materials and Methods:In a cross- sectional study, 49 consecutive neonates hospitalized in NICU of Besat hospital with diagnosis of AKI from October 2009 to October 2011 were investigated through census sampling method. AKI was diagnosed based on urine output and serum creatinine levels.Results:The prevalence of AKI was 1.54% (49 out of 3166 newborns hospitalized in NICU) with the female: male was 7:1. Thirty-nine patients (79.5%) were full-term neonates. Oliguria was observed in 38 (77.5%) patients. Sepsis was the most common predisposing factor for AKI in 77.5% of patients (n = 38) accompanied with the highest mortality rate among other factors (30.5%). Other leading causes of AKI included hypovolemia secondary to dehydration, followed by hypoxia secondary to RDS, patent ductus arteriosus, posterior urethral valve, asphyxia, and renal venous thrombosis. A positive relationship was observed between neonates' age, sex, urine output, and also between serum creatinine levels with initiation of dialysis. The mortality rate among the newborns hospitalized with AKI was 36.7%. Eighteen (36.7%) newborns were treated with peritoneal dialysis (PD) of whom 10 patients (55.6%) died, 31 patients were managed conservatively of whom five neonate died (25.9%).Discussion:Prognosis of AKI in the oliguric neonates requiring PD is very poor. It is thus recommended to prevent AKI by predicting and rapid diagnosis of AKI in patients with potential risk factors and also by early and effective treatment of such factors in individuals with AKI.

Association of In-hospital outcome of Acute Kidney Injury (AKI) with etiology among newborns at a tertiary care unit

“…Gharehbaghi et al 17 from Iran also reported male to female ratio was 2.03:1 (67% versus 33%) showing same trends as that of our study results. Similar results have been reported by Airede et al 18 Kandoth et al 19 and Bourquia et al 20 However Momtaz et al 21 have reported different findings showing female gender predominating among newborns with AKI. Acute renal failure is generally observed in first few days of life to couple of weeks time.…”

“…Gharehbaghi et al 17 from Iran also reported 5.26 ± 6.2 days ranging from 2–28 days. Similarly, Momtaz et al 21 reported 7.7 ± 6.3 days mean age in newborns with AKI. Mean weight of these neonates was 2545.05 ± 600.42 grams (range; 1000 grams to 4000 grams).…”

Acute kidney injury among critically ill neonates in a tertiary hospital in Tanzania; Prevalence, risk factors and outcome

“…Congenital abnormalities of kidney and genital-urinary tract are also reported to contribute to AKI among neonates [16]. In our findings, 29 out of 74 participants with AKI who had KUB ultrasound scans had congenital abnormalities of the genitourinary system detected only by ultrasound.…”

“…Neonatal AKI may result in devastating outcomes including prolonged hospital stays, chronic kidney disease, end stage renal failure and deaths. [5,14,16,21,22]. Mortality as high as 73% was reported for children with AKI in a systematic review of AKI in sub-Saharan Africa [5].…”

Predictive Factors for Acute Renal Failure in Neonates with Septicemia

“…In the present study, about 15% of patients died and 85% were discharged. Overall, the predisposing factors include underlying etiology, female gender, birth asphyxia, low birth weight, multiorgan failure, hypotension, septicemia, profound acidosis, shock, oligoanuria, nephrotoxic drugs, vasopressor treatment, mechanical ventilation, and peritoneal dialysis (13,15).…”