Acute kidney injury in preterm neonates with ≤30 weeks of gestational age and its risk factors

Ladeiras, Rita; Flôr-de-Lima, Filipa; Soares, Henrique; Oliveira, B.M.P.M.; Guimarães, Hercília

doi:10.23736/s0026-4946.18.04964-2

Cited by 7 publications

(4 citation statements)

References 37 publications

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“…This finding is lower than studies done in the USA(38.0%) among extremely low gestational ages and (30.3%) among preterm neonates of less than 30 weeks of gestation [ 18 , 26 ], Portugal (22.6%) among preterm neonates with ≤ 30 weeks of gestational age [ 27 ]. The possible explanation for this is a difference in the study design, study population gestational age, study setting (institutional level difference).…”

Section: Discussioncontrasting

confidence: 58%

Magnitude and associated factors of acute kidney injury among preterm neonates admitted to public hospitals in Bahir Dar city, Ethiopia 2022: cross-sectional study

et al. 2023

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Background Acute kidney injury is an independent risk factor for morbidity and mortality in critically ill neonates. Although the magnitude of preterm neonates is high and a major risk for acute kidney injury, there is a paucity of information regarding the magnitude and associated factors of acute kidney injury among preterm neonates in the study area. Therefore, the aim of this study was to assess magnitude and associated factors of acute kidney injury among preterm neonates admitted to public hospitals in Bahir Dar city, Ethiopia, 2022. Methods An institutional-based cross-sectional study was conducted among 423 preterm neonates admitted to public hospitals in Bahir Dar city from May 27 to June 27, 2022. Data were entered into Epi Data Version 4.6.0.2 transferred to Statistical Package and Service Solution version 26 for analysis. Descriptive and inferential statistics were employed. A binary logistic regression analysis was done to identify factors associated with acute kidney injury. Model fitness was checked through Hosmer-Lemeshow goodness of fit test. Variables with a p-value < 0.05 were considered as statistically significant in the multiple binary logistic regression analysis. Result Out of 423 eligible, 416 neonatal charts were reviewed with a response rate of 98.3%.This study revealed that the magnitude of acute kidney injury was 18.27% (95% CI = 15–22). Very low birth weight (AOR = 3.26; 95% CI = 1.18–9.05), perinatal asphyxia (AOR = 2.84; 95%CI = 1.55–5.19), dehydration (AOR = 2.30; 95%CI = 1.29–4.09), chest compression (AOR = 3.79; 95%CI = 1.97–7.13), and pregnancy-induced hypertension (AOR = 2.17; 95%CI = 1.20–3.93) were factors significantly associated with the development of neonatal acute kidney injury. Conclusion Almost one in five admitted preterm neonates developed acute kidney injury. The odds of acute kidney injury were high among neonates who were very low birth weight, perinataly asphyxiated, dehydrated, recipients of chest compression, and born to pregnancy-induced hypertensive mothers. Therefore, clinicians have to be extremely cautious and actively monitor renal function in those neonatal population in order to detect and treat acute kidney injury as early as possible.

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Section: Discussioncontrasting

confidence: 58%

Magnitude and associated factors of acute kidney injury among preterm neonates admitted to public hospitals in Bahir Dar city, Ethiopia 2022: cross-sectional study

et al. 2023

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“…In the current study with preterm pigs, we demonstrated for the first time that CA, induced by IA LPS exposure, resulted in renal inflammation both at birth and 5 days after preterm birth with the involvement of innate and adaptive immune activation. Our data imply that prenatal insults may play a critical role in determining neonatal kidney outcomes and may explain the high incidence of AKI in preterm infants (46,(57)(58)(59)(60), although reduced gestational age at birth is also a risk factor (61).…”

Section: Discussionmentioning

confidence: 75%

Prenatal Endotoxin Exposure Induces Fetal and Neonatal Renal Inflammation via Innate and Th1 Immune Activation in Preterm Pigs

et al. 2020

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Chorioamnionitis (CA) predisposes to preterm birth and affects the fetal mucosal surfaces (i.e., gut, lungs, and skin) via intra-amniotic (IA) inflammation, thereby accentuating the proinflammatory status in newborn preterm infants. It is not known if CA may affect more distant organs, such as the kidneys, before and after preterm birth. Using preterm pigs as a model for preterm infants, we investigated the impact of CA on fetal and neonatal renal status and underlying mechanisms. Fetal pigs received an IA dose of lipopolysaccharide (LPS), were delivered preterm by cesarean section 3 days later (90% gestation), and compared with controls (CON) at birth and at postnatal day 5. Plasma proteome and inflammatory targets in kidney tissues were evaluated. IA LPSexposed pigs showed inflammation of fetal membranes, higher fetal plasma creatinine, and neonatal urinary microalbumin levels, indicating renal dysfunction. At birth, plasma proteomics revealed LPS effects on proteins associated with renal inflammation (upregulated LRG1, down-regulated ICA, and ACE). Kidney tissues of LPS pigs at birth also showed increased levels of kidney injury markers (LRG1, KIM1, NGLA, HIF1A, and CASP3), elevated molecular traits related to innate immune activation (infiltrated MPO + cells, complement molecules, oxidative stress, TLR2, TLR4, S100A9, LTF, and LYZ), and Th1 responses (CD3 + cells, ratios of IFNG/IL4, and TBET/GATA3). Unlike in plasma, innate and adaptive immune responses in kidney tissues of LPS pigs persisted to postnatal day 5. We conclude that prenatal endotoxin exposure induces fetal and postnatal renal inflammation in preterm pigs with both innate and adaptive immune activation, partly explaining the potential increased risks of kidney injury in preterm infants born with CA.

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“…As nephron development is typically complete around 36 weeks of gestation [1], infants with shorter gestations and lower birth weights are particularly susceptible to disrupted kidney development [2, 3]. In a recent study of over 4 million Swedish birth records, shorter gestations were associated with an increased lifelong risk of chronic kidney disease (CKD) [4].…”

Section: Introductionmentioning

confidence: 99%

“…In a recent study of over 4 million Swedish birth records, shorter gestations were associated with an increased lifelong risk of chronic kidney disease (CKD) [4]. Moreover, preterm birth and/or low birth weight are associated with a higher risk of acute kidney injury (AKI) [3]. However, the widely utilized index of kidney function, serum creatinine (SCr), is suboptimal for detecting subclinical renal damage as it may not change until 25–50% of kidney function is lost [5].…”

Section: Introductionmentioning

confidence: 99%

Length of gestation and birth weight are associated with indices of combined kidney biomarkers in early childhood

et al. 2019

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Infants born prematurely or with low birth weights are more susceptible to kidney dysfunction throughout their lives. Multiple proteins measured in urine are noninvasive biomarkers of subclinical kidney damage, but few studies have examined the joint effects of multiple biomarkers. We conducted an exploratory study of 103 children in the Programing Research in Obesity, Growth, Environment, and Social Stressors (PROGRESS) longitudinal birth cohort, and measured nine proteins selected a priori in banked spot urine samples collected at ages 4–6. The goal of our study was to explore the combined effects of kidney damage biomarkers previously associated with birth outcomes. To do this, we generated kidney biomarker indices using weighted quantile sum regression and assessed associations with length of gestation or birth weight. A decile increase in each kidney biomarker index was associated with 2-day shorter gestations (β = -2.0, 95% CI: -3.2, -0.9) and 59-gram lower birth weights (β = -58.5, 95% CI: -98.3, -18.7), respectively. Weights highlighting the contributions showed neutrophil gelatinase-associated lipocalin (NGAL) (60%) and osteopontin (19%) contributed most to the index derived for gestational age. NGAL (66%) and beta-2-microglobulin (10%) contributed most to the index derived for birth weight. Joint analyses of multiple kidney biomarkers can provide integrated measures of kidney dysfunction and improved statistical assessments compared to biomarkers assessed individually. Additionally, shorter gestations and lower birth weights may contribute to subclinical kidney damage measurable in childhood.

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Acute kidney injury in preterm neonates with ≤30 weeks of gestational age and its risk factors

Cited by 7 publications

References 37 publications

Magnitude and associated factors of acute kidney injury among preterm neonates admitted to public hospitals in Bahir Dar city, Ethiopia 2022: cross-sectional study

Magnitude and associated factors of acute kidney injury among preterm neonates admitted to public hospitals in Bahir Dar city, Ethiopia 2022: cross-sectional study

Prenatal Endotoxin Exposure Induces Fetal and Neonatal Renal Inflammation via Innate and Th1 Immune Activation in Preterm Pigs

Length of gestation and birth weight are associated with indices of combined kidney biomarkers in early childhood

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