Acute kidney injury in the fetus and neonate

Abstract

SUMMARY Acute kidney injury (AKI) is an under-recognized morbidity of neonates; the incidence remains unclear due to the absence of a unified definition of AKI in this population and because previous studies have varied greatly in screening for AKI with serum creatinine and urine output assessments. Premature infants may be born with less than half of the nephrons compared with term neonates, predisposing them to chronic kidney disease (CKD) early on in life and as they age. AKI can also lead to CKD, and premature infants with AKI may be at very high risk for long-term kidney problems. AKI in neonates is often multifactorial and may result from prenatal, perinatal, or postnatal insults as well as any combination thereof. This review focuses on the causes of AKI, the importance of early detection, the management of AKI in neonates, and long-term sequela of AKI in neonates.

Low Renal Oxygen Saturation at Near-Infrared Spectroscopy on the First Day of Life Is Associated with Developing Acute Kidney Injury in Very Preterm Infants

“…More recent definitions are based upon the increase of SCr levels in serial measurements, joined to urine output over 24 h [5], especially in accordance with studies on VLBW infants [1, 20, 21]. However, these definitions of AKI are still under debate and, due to the lack of urine output measures after the first day of life in our cohort, we preferred to use this simple cutoff value, widely employed in previous studies.…”

“…All these conditions may induce renal hypoperfusion and hypoxia [7-9]. As focused on in very recent reviews, not only the assessment of renal function is often limited and difficult in preterm infants [5, 10], but additionally, kidney hypoperfusion preceding renal dysfunction may be subclinical [11]. So, research of early markers of both renal injury and hypoperfusion is advocated.…”

“…AKI was defined as absolute serum creatinine (SCr) > 130 μmol/L after the first day of life (day 1). This is the most widely used definition of AKI in neonates since 1995 [5]. The secondary outcome measure was the SCr peak (maximal SCr concentration from day 2 to 7 of life).…”

“…A more recent diagnostic approach looks to neonatal AKI as an underrecognized disease moving along a continuum from mild renal dysfunction to the ultimate state of the disease, i.e., kidney failure [5], and where a chief challenge is to identify each degree of acute reduction of renal function.…”

Management of acute kidney injury in children

“…In neonates with ischaemic AKI (e.g. following sepsis, asphyxia, post-cardiac surgery), maintenance of optimal mean arterial pressure with avoidance of nephrotoxic agents 28 , is the single most important step in the management. At present, PD is the modality of choice for RRT in neonates 29 .…”