Renal injury in perinatal hypoxia: ultrasonography and changes in renal function

Streitman, K; Tóth, Árpád; Horváth, István; Tálosi, Gyula

doi:10.1007/s004310100769

Cited by 17 publications

(13 citation statements)

References 10 publications

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“…Hypoxemic neonates had elevated tubular markers and a transient renal hyperechogenicity in the 1st week of life [34]. Saarela et al [35] described high urinary excretion of Ca and b 2 -microglobulin in patients with nephrocalcinosis associated with prematurity, even in early childhood.…”

Section: Resultsmentioning

confidence: 98%

Development of nephrocalcinosis in very low birth weight infants

Hein¹,

Richter²,

Manz

et al. 2004

Pediatric Nephrology

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Premature infants undergo intensive growth during the postnatal period. Adequate mineralization is dependent on sufficient intake of calcium (Ca) and phosphorus (P). However, Ca and P supplementation can be associated with some risks, for example development of nephrocalcinosis. We investigated pathophysiological risk factors in premature very low birth weight (VLBW) infants associated with the development of nephrocalcinosis. From June 1994 to September 1995 all preterm neonates with a birth weight below 1,500 g were screened prospectively. At regular intervals of 2 weeks, ultrasonography (US) of the kidneys was performed and parameters of mineral metabolism were assessed in blood and spot urine samples. For analysis, premature infants with nephrocalcinosis (group N) were compared with infants without nephrocalcinosis (group R) and with a retrospectively pair-matched subgroup of premature infants without nephrocalcinosis (control group C) taken from the same study. Nephrocalcinosis was detected in 20 of 114 preterm neonates (group N, 17.5%). Of these 20 infants with nephrocalcinosis, 16 presented with a tendency towards systemic acidosis (pH<7.25) on day 2-7, compared with only 4 of 20 premature infants of the control group. Premature infants of group N had a lower serum P at 2 weeks of life and 5 (versus 0 patients of the control group C) had transient hypophosphatemia (serum P<1.6 mmol/l). Moreover, the Ca/creatinine ratio in spot urine specimens tended to be higher (P<0.1) in patients developing nephrocalcinosis. There were no significant differences in the duration of ventilation, the length of stay in the intensive care unit, and duration and frequency of furosemide and steroid treatment between the groups N and C. VLBW premature infants developing nephrocalcinosis frequently presented with slightly impaired acid-base homoeostasis within the 1st week, followed by signs of impaired mineralization (and immature or impaired renal function) within 2 weeks. In VLBW premature infants, close observation of acid-base status and regular analysis of spot urine specimens (Ca, P, creatinine) during the first weeks of life may help to identify those premature infants at risk for nephrocalcinosis.

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Section: Resultsmentioning

confidence: 98%

Development of nephrocalcinosis in very low birth weight infants

Hein¹,

Richter²,

Manz

et al. 2004

Pediatric Nephrology

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“…In contrast to the hypoechoic medullary pyramids demonstrated by a sonogram of the normal neonatal kidney, renal medullary hyperechogenicity has been observed in association with severe perinatal renal injury, kidney malformations or nephrocalcinosis [5,6,7,8]. Although rarely, this sonographic finding has also been documented in newborn infants with transient renal dysfunction [9,10,11,12,13,14,15].…”

Section: Introductionmentioning

confidence: 84%

“…Hence, these rates may not necessarily reflect renal tubular handling of uric acid throughout the episode of ARF. It is plausible that the transient hyperuricemia, a well known phenomenon in perinatal asphyxia [7,24], results in increased urinary excretion of urates, which, in turn, leads to precipitation of uric acid in the collecting ducts where urine is acid and concentrated. The ensuing tubular obstruction results in renal failure associated with renal medullary hyperechogenicity (Fig.…”

Section: Discussionmentioning

confidence: 99%

Neonatal transient renal failure with renal medullary hyperechogenicity: clinical and laboratory features

et al. 2005

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Sonographic findings of renal medullary hyperechogenicity have been observed in the neonate in association with severe perinatal renal injury, kidney malformations or nephrocalcinosis, and, rarely, in newborn infants with transient renal failure. The aim of the study was to describe the entity of neonatal transient renal failure with renal medullary hyperechogenicity (NTRFMH). We studied nine term neonates, born between August 1999 and February 2004 in our institution (0.1% of the live born infants), who developed transient renal dysfunction after birth, and in whom renal sonograms showed bilateral medullary hyperechogenicity. Seven of the infants (78%) had anuria until 30-45 hours of age, and two (22%) had oliguria. Peak serum creatinine levels ranged between 0.61 and 1.62 mg/dL (mean: 1.09+/-0.27 mg/dL) at 2-3 days of life. Additional findings included proteinuria in nine infants (100%), uric acid crystalluria in seven (78%), hyperuricemia in four (44%), and hypertension in one (11%). Hyperuricosuria was demonstrated in one out of the seven patients in whom this parameter was determined. Urinary excretion rates of calcium, phosphorus and oxalic acid were normal, as were urinary levels of amino acids and organic acids. Full clinical recovery accompanied by normalization of all laboratory parameters was observed in all infants by 4-6 days of life. Subsequent follow-up showed normal renal function, no urinary abnormalities, and normal renal sonograms in all infants. Our summary of the nine infants with NTRFMH reported on here and a review of 19 cases of this condition reported in the literature reveal a not-so-rare entity of unclear etiology, but excellent prognosis. Physicians caring for neonates should be aware of this benign and transient condition.

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“…Several studies suggest that higher uric acid formation may provide a significant antioxidant defense against peroxynitrite and nitric oxide-derived oxidants. 19,20 However, the role of elevated uric acid levels measured in term and preterm neonates with perinatal asphyxia 21,22 remains unclear. Further characterization of the ATP degradation pathway and free-radical production in neonates is required and should include both normoxic and hypoxic newborns.…”

Section: Limitationsmentioning

confidence: 99%

Effect of mode of birth on purine and malondialdehyde in umbilical arterial plasma in normal term newborns

Calderon

Rawson

et al. 2008

J Perinatol

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Objective: To examine the effect of mode of birth on plasma purine and malondialdehyde levels in normal term infants.Study Design: Umbilical arterial cord blood was obtained immediately after birth from a convenience sample of 119 normal term newborns born by vaginal delivery, with or without oxytocin augmentation or by elective cesarean delivery. Plasma was analyzed for purine and/or malondialdehyde levels. Numeric data were analyzed utilizing independent samples t-test and ordinal data were analyzed using MannWhitney test. Correlation coefficients were obtained using Spearman's r.Result: Uric acid levels were significantly elevated (P<0.001) in neonates undergoing vaginal birth, compared to neonates born by elective cesarean delivery. When the effect of oxytocin and length of labor was analyzed, neonates born to mothers on oxytocin had lower hypoxanthine, significantly lower xanthine (P ¼ 0.05) and higher uric acid levels. In addition, malondialdehyde levels were significantly higher (P<0.006) in neonates born to mothers who received oxytocin compared to neonates born to mothers without oxytocin augmentation. We also found significant correlations between malondialdehyde (MDA) and hypoxanthine (r ¼ À0.465, P<0.039) and between MDA and xanthine (r ¼ À0.753, P ¼ 0.003) in neonates born via oxytocin-augmented birth. Mode of birth had no statistically significant effect on clinical outcomes, although infants born by elective cesarean had higher incidence of acute respiratory distress and transient tachypnea of the newborn compared to those born vaginally. Conclusion:Neonates born by elective cesarean had the lowest purine levels in cord blood compared to neonates born vaginally. Oxytocin augmentation is associated with some degree of uterine hyperstimulation which may enhance the ATP degradation pathway resulting in the rapid conversion of hypoxanthine to xanthine and xanthine to uric acid. Significantly higher MDA levels in neonates whose mothers received oxytocin as well as significant correlation between MDA and the purines hypoxanthine and xanthine, suggest free-radical production, most likely due to xanthine oxidase activation. However, despite differences in plasma purine and malondialdehyde levels, no significant differences were seen in neonatal outcome. Further studies are required to fully characterize the effect of mode of birth on purine metabolism and free-radical production.

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Renal injury in perinatal hypoxia: ultrasonography and changes in renal function

Cited by 17 publications

References 10 publications

Development of nephrocalcinosis in very low birth weight infants

Development of nephrocalcinosis in very low birth weight infants

Neonatal transient renal failure with renal medullary hyperechogenicity: clinical and laboratory features

Effect of mode of birth on purine and malondialdehyde in umbilical arterial plasma in normal term newborns

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