Acute kidney injury in asphyxiated neonates and its correlation to hypoxic ischemic encephalopathy staging

Abstract

Background: Acute kidney injury (AKI) is a common consequence of perinatal asphyxia, occurring in up to 56% of these neonates. It is important to recognize AKI in asphyxiated neonates to facilitate administration of appropriate fluids and electrolytes to improve their outcome. Objectives: To determine the incidence of AKI in asphyxiated neonates and its correlation with severity of hypoxic-ischemic encephalopathy (HIE). Methods: 135 term neonates were enrolled - 90 asphyxiated and 45 healthy neonates. AKI was diagnosed when serum creatinine was >1.5 mg/dl regardless of the rate of urine output (UOP). Neonates with AKI were managed as per standard protocol. Results: Of the 90 asphyxiated neonates, 68 (75.6%) had AKI including 58 (85.3%) neonates with pre-renal AKI and 10 (14.7%) with intrinsic AKI. Out of the 68 AKI, 22 (32.36%) had oliguric AKI and 46 (67.64%) had non-oliguric AKI. Levels of blood urea and serum creatinine were significantly higher in asphyxiated neonates as compared to healthy controls (p<0.001). There was no significant difference in UOP in control and study groups. Sonographic abnormalities were seen mostly in oliguric babies and indicated bad prognosis. Mortality was higher in babies with oliguric AKI. Conclusions: Perinatal asphyxia is an important cause of neonatal AKI. The majority had non-oliguric AKI and responded well to fluid challenge. Abnormalities in the renal function correlate well with the severity of HIE. Intrinsic AKI, oliguria, hyponatremia, reduced creatinine clearance, and abnormal sonographic scan suggest bad prognosis in neonatal AKI secondary to perinatal asphyxia.

Study of incidence of acute kidney injury in asphyxiated neonates with hypoxic ischemic encephalopathy

“…Almost similar observations were made by Agrawal et al 26 Although in our study only 9% AKI cases were found in babies with grade I HIE, but in the study by Agrawal et al 53% cases of AKI were observed with 100% pre-renal type. 26 In this study blood urea and serum creatinine values were significantly higher in asphyxiated babies than control group babies (p<0.0001). The studies by Gopal and Agrawal et al have similar findings.…”

“…Various studies have similar findings. 16,23,25,26 But contrary to our study Gupta et al had observation of 78.8% incidence of non-oliguric AKI, while Jayshree et al has reported 30.8% non-oliguric. 15,22 In our study incidence of AKI in those asphyxiated babies who have suffered from HIE were studied and we observed that 9.1% neonates of type I HIE had AKI, of which 50% had pre renal and 50% intrinsic renal disease.…”

“…11,15,16,[22][23][24] But the studies by Mohan et al and Agrawal et al had significantly higher incidence of AKI (72% and 75.5%) respectively. 25,26 In our study 73% cases had prerenal AKI and 27% intrinsic AKI. Non-oliguric AKI was observed in 61% case while oliguric AKI was observed in 39% cases.…”

“…The studies by Gopal and Agrawal et al have similar findings. 11,26 The level of serum creatinine was significantly higher in stage III HIE babies than stage II and I babies (p<0.0001). Medani et al has similar observation in his study.…”

Prevalence of Acute Kidney Injury in Patients with Perinatal Asphyxia in Tertiary Hospital

“…8 Similar results are seen in various studies as well. 14,17,20 Highest number (86%) of ARF was seen in neonates with HIE III in a study done by Hadzimuratovi Emnia et al, which indicated more renal problem in higher grades of HIE. 13 Renal involvement is in perinatal asphyxia is obvious after second day.…”