Acute Kidney Injury in Neonates: A Single-Center Experience
DOI:
https://doi.org/10.32007/jfacmedbagdad.2048Keywords:
Acute kidney disease, NICU, neonates, prevalence, KDIGO criteriaAbstract
Background: Neonatal intensive care unit infants frequently experience acute kidney damage. Estimates of the prevalence of acute kidney vary depending on the definitions used. In Iraq, studies addressing the prevalence and risk factors of acute kidney injury in this age group are scarce, none of which has implicated the KDIGO diagnostic and staging criteria.
Objectives: To describe the prevalence, demographics, risk factors, etiology, and staging of acute kidney injury using KDIGO criteria in the Neonatal intensive care unit and correlate these findings with patient outcomes.
Methods: A retrospective study was conducted in the Neonatal Intensive Care Unit/ CWTH/ Medical City Complex/ Baghdad during the period from the 1st of August 2019 to the 15th of January 2020. All neonates diagnosed with acute kidney injury according to KDIGO –classification 2012 and admitted to the neonatal intensive care unit were included in this study. Demographics, clinical staging, and investigations were retrieved from patients' notes.
Results: The prevalence of acute kidney damage was 7.2%. The mean gestational age of the patients was 36.8 ± 2.9 weeks, 58% of them were full-term, with a male-to-female ratio of 1.40:1. Stage I patients represented 35.1%, 43.2% were stage 2, and 21.6% had severe stage 3. Acute kidney injury-related mortality was 35.1%. The term female sex, high birth weight, and age younger than seven days at diagnosis predicted a bad prognosis. Vaginally delivered, stage III acute kidney injury-KDIGO, and peritoneal dialysis patients had the worst outcomes. Asphyxia was a major cause of acute kidney injury (P=0.001). High blood urea (P=0.01), low PH (P=0.009), low HCO3 (P=0.001), low WBC count (P=0.001), and low platelet count (0.001) were associated with unfavorable outcomes.
Conclusions: The prevalence of acute kidney injury, according to KIDGO diagnostic and staging criteria, is 7.1%. Asphyxia, female gender, and vaginal deliveries are variables associated with poor prognosis in addition to advanced illness stage and laboratory indicators.
Received: Dec. 2022
Accepted: Jun 2023
Published: Oct.2023
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References
Watson A. Renal disease in the neonate. In: Mcintosh N, Stenson B, editors. Farfar and Ameils text book of pediatrics. 6 ed. Edinburgh: Churchill Livingstone; 2003. p. 324-30.
Makris K, Spanou L. Acute Kidney Injury: Definition, Pathophysiology and Clinical Phenotypes. The Clinical biochemist Reviews. 2016; 37(2):85-98.
Yanik M, Askenazi D, Ambalavanan N. Acute kidney injury in neonates. NeoReviews. 2015; 16(10):e586-e92. https://doi.org/10.1542/neo.16-10-e586
Coleman C, Tambay Perez A, Selewski DT, Steflik HJ. Neonatal Acute Kidney Injury. Frontiers in Pediatrics. 2022; 10.
https://doi.org/10.3389/fped.2022.842544
Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno DE, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. The lancet child & adolescent health. 2017; 1(3):184-94.
Gomella TL, Cunningham MD, Eyal FG, Tuttle DJ. Neonatology: management, procedures, on-call problems, diseases, and drugs: McGraw-Hill Education Medical New York, NY; 2013.
Askenazi D, Selewski D, Willig L. Acute Kidney Injury and Chronic Kidney Disease. In: Christine A, Gleason SEJ, editors. Avery's Diseases of the Newborn. 10 ed. Philadelphia. : Elsevier; 2018. p. 1280-300.
https://doi.org/10.1016/b978-0-323-40139-5.00090-5
Nandhagopal N, Firdaus U, Ali S, Afzal K. Incidence, risk factors, and outcome of acute kidney
injury in hospitalized term newborns. Journal of clinical neonatology 2020; 9(2):121-4. https://doi.org/10.4103/jcn.jcn_84_19
Azat NFA, Abdalmahdi S. A, Naoom MB. Acute renal failure in neonates. Iraqi Postgraduate Medical Journal. 2011; 10(2).
Shalaby MA, Sawan ZA, Nawawi E, Alsaedi S, Al-Wassia H, Kari JA. Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study. Pediatric nephrology (Berlin, Germany). 2018; 33(9):1617-24. https://doi.org/10.1007/s00467-018-3966-7
Youssef D, Abd-Elrahman H, Shehab MM, Abd-Elrheem M. Incidence of acute kidney injury in the neonatal intensive care unit. Saudi journal of kidney diseases and transplantation. 2015;26(1):67.
https://doi.org/10.4103/1319-2442.148738
Momtaz HE, Sabzehei MK, Rasuli B, Torabian S. The main etiologies of acute kidney injury in the newborns hospitalized in the neonatal intensive care unit. Journal of clinical neonatology. 2014; 3 (2):99.
https://doi.org/10.4103/2249-4847.134691
El-Badawy AA, Makar S, Abdel-Razek A-RA, Abd Elaziz D. Incidence and risk factors of acute kidney injury among the critically ill neonates. Saudi Journal of Kidney Diseases and Transplantation. 2015;26(3):549.
https://doi.org/10.4103/1319-2442.157362
Bansal SC, Nimbalkar AS, Kungwani AR, Patel DV, Sethi AR, Nimbalkar SM. Clinical profile and outcome of newborns with acute kidney injury in a level 3 neonatal unit in Western India. Journal of Clinical and Diagnostic Research: JCDR. 2017; 11 (3):SC01. https://doi.org/10.1136/archdischild-2012-302724.1324
Charlton JR, Boohaker L, Askenazi D, Brophy PD, D’Angio C, Fuloria M, et al. Incidence and risk factors of early onset neonatal AKI. Clinical Journal of the American Society of Nephrology. 2019;14(2):184-95.
https://doi.org/10.2215/cjn.03670318
Nickavar A, Khosravi N, Mazouri A. Predictive Factors for Acute Renal Failure in Neonates with Septicemia.2017;5(4):e61627. https://doi.org/10.5812/pedinfect.61627
Kapoor K, Jajoo M, Dabas V. Predictors of mortality in out born neonates with acute renal failure; an experience of a single center. Iranian journal of pediatrics. 2013;23(3):321.
Charlton JR, Portilla D, Okusa MD. A basic science view of acute kidney injury biomarkers. Nephrology Dialysis Transplantation. 2014; 29 (7): 1301-11. https://doi.org/10.1093/ndt/gft510
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Copyright (c) 2023 Ali Ahmed Khudhair , Khalid Zuhair Naama, Ammar Khaled Khaleel , Yasir Ibrahim Saadi
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