Urine or You’re Out?

Abstract

In this issue of CJASN, De Mul et al. (1) present data to support the use of higher thresholds for the urine output criteria in the definition of neonatal AKI. The authors examine nearly 500 neonates born ,30 weeks of gestation from two centers over 4 years. They compared urine output thresholds of 1, 1.5, and 2 ml/kg per hour over a 24-hour period within the first 7 days after birth. Important findings from this study include (1) approximately 27% of AKI is not detected by serum creatinine, (2) AKI within the first week after birth is associated with four-fold higher odds of mortality after adjustment, and (3) higher urine output thresholds improve the discriminative performance of AKI to predict mortality. In the following editorial, we will elaborate on the significance of these findings from the perspective of both a neonatologist and a pediatric nephrologist.