Angiotensin converting enzyme inhibitors induced acute kidney injury in newborn

Angiotensin converting enzyme inhibitors (ACEI) are known to cause fetopathies and acute kidney injury (AKI) in neonates. It is important to monitor neonates on ACEI to prevent severe rebound hypotension as well as an acute renal impairment or failure.     

中性粒细胞明胶酶相关脂质运载蛋白在新生儿窒息急性肾损伤的早期诊断价值

目的 通过检测新生儿窒息急性肾损伤(AKI)患者脐血、血清、尿液中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平的变化,为临床早期识别新生儿窒息AKI提供依据.方法 收集2018年1月至2019年12月我院产科出生,新生儿科收治的新生儿窒息的足月儿72例作为研究对象,分别检测脐血NGAL,出生后第1、3天血NGAL、血...     

Waist circumference in predicting gestational diabetes mellitus

Abstract

Peritoneal dialysis (PD) is considered as the most common form of renal replacement therapy for newborns including preterms with acute kidney injury (AKI). Although there are several reports describing successful PD performed for AKI in preterm infants, there is no data describing the use of PD to treat AKI in preterm newborns with congenital diaphragmatic hernia (CDH), which is one of the contraindications for PD.

We present a preterm newborn with CDH, truncus arteriosus and AKI treated with PD and emphasize that PD may be successfully performed with caution even in cases of contraindications when other renal replacement therapies cannot be used.     

Does therapeutic hypothermia reduce acute kidney injury among term neonates with perinatal asphyxia? – a randomized controlled trial

Objective: The objective of this study is to evaluate whether therapeutic hypothermia reduces the incidence of acute kidney injury (AKI) among term neonates perinatal asphyxia.

Methods: This randomized controlled trial conducted in a tertiary care teaching hospital, south India included 120 term neonates with perinatal asphyxia who were randomized to receive either therapeutic hypothermia or standard supportive care. Renal parameters of neonates in both the groups were monitored and AKI was ascertained as per Acute Kidney Injury Network criteria.

Results: The incidence of AKI was less in therapeutic hypothermia group compared to standard treatment group (32% versus 60%, p?<?0.05). The incidence of Stages 1, 2, and 3 AKI was 22%, 5%, and 5% in therapeutic hypothermia group compared with 52%, 5%, and 3%, respectively, in the standard treatment group. The mortality was less in therapeutic hypothermia group compared with the standard treatment group (26% versus 50%, p?<?0.05).

Conclusion: Therapeutic hypothermia reduces the incidence and severity of AKI among term neonates with perinatal asphyxia.     

儿童非紫绀型先天性心脏病体外循环术后急性肾损伤相关危险因素分析

目的探究儿童非紫绀型先天性心脏病体外循环术后急性肾损伤(AKI)相关危险因素。方法选取2013年8月至2016年8月在湖南省儿童医院心胸外科行体外循环手术治疗的非紫绀型先天性心脏病患儿450例作为研究对象,将患儿按术后是否出现AKI进行分组,AKI组80例,非AKI组370例。收集患儿的一般资料及临床资料,通过单因素分析以及Logistic回归分析探究其相关危险因素。结果两组患儿在性别、体质量、尿素氮、左室射血分数、血红蛋白方面比较差异无统计学意义(P0.05)。两组在年龄、血肌酐、肺炎或心力衰竭史、体外循环时间及主动脉阻断时间、术后低血压方面比较差异有统计学意义(P0.05)。通过Logistic对因素回归分析发现,年龄≤1岁、肺炎或心力衰竭史、体外循环时间以及主动脉阻断时间是危险因素。结论在非紫绀型先天性心脏病患儿行体外循环手术治疗中,选择手术年龄、缩短体外循环时间、缩短主动脉阻断时间以及预防并发症是有效的控制手段,可以降低患儿AKI的发病率。     

Acute kidney injury requiring dialysis in obstetric patients: a series of 55 cases in Brazil

Objective  To investigate the risk factors associated with oliguria and death in obstetric patients with acute kidney injury (AKI). Methods  The study group included all obstetric patients with AKI, under dialytic treatment, in Hospital Geral César Cals, Fortaleza, Brazil, from January 2000 to December 2006. AKI were classified according to the RIFLE criteria. Univariate and multivariate analysis were performed to investigate the factors associated with oliguria and death. Results  A total of 55 patients were included. Their average age was 26.2 ± 6.7 years. The main etiologies of AKI were pregnancy-related hypertension (41.8%), HELLP syndrome (40%), puerperal sepsis (14.5%), abruption placentae (9.1%), hemolytic uremic syndrome (9.1%) and thrombotic thrombocytopenic purpura (5.5%). Oliguria was observed in 36 cases (65%). Death occurred in 17 cases (30.9%). Factors associated with oliguria were, diagnosis of HELLP syndrome, hyperbilirubinemia and death. Factors associated with death were, presence of puerperal sepsis, hyperbilirubinemia, hypotension, oliguria and low levels of HCO₃. Conclusion  AKI is a rare but potential fatal complication in obstetric patients. RIFLE criteria seem to have association with mortality. There are important factors associated with oliguria and death, which must be prompt recognized to the institution of adequate therapeutic measures.     

Analysis of urine biomarkers for early determination of acute kidney injury in non-septic and non-asphyxiated critically ill preterm neonates

Objective: We designed the present study to test the hypothesis that urinary biomarkers might predict acute kidney injury (AKI) development in non-septic and non-asphyxiated critically ill preterm infants. We evaluated urine (u) sistatin–C (uCys-C), kidney injury molecule–1 (uKIM–1) and neutrophil gelatinase associate lipocaline (uNGAL) as markers of AKI.

Methods: Sixty-four preterm infants with gestational age between 28 and 32 weeks were included in this study. Biomarkers were measured on day of life (DOL) 1, 3, and 7.

Results: uNGAL levels in the AKI group were significantly higher than in no-AKI group on DOL 1, 3 and 7 (p?=?0.016, p?=?0.007 and p?=?0.0014, respectively).

Conclusions: uNGAL is sensitive, early, and noninvasive AKI biomarkers, increasing significantly in non-septic and non-asphyxiated critically ill preterm neonates.     

Nephrotoxic medication exposure in very low birth weight infants

Abstract

Objective: To quantify exposure to potentially nephrotoxic medications among very low birth weight (VLBW) infants and determine the relationship of nephrotoxic medication exposure to acute kidney injury (AKI) in this vulnerable population.

Methods: We reviewed 107 VLBW infants who survived to discharge from April 2011 to March 2012 and measured exposure to the following nephrotoxic medications: acyclovir, amikacin, amphotericin B, gentamicin, ibuprofen, indomethacin, iohexol, tobramycin and vancomycin. Acute kidney injury was determined by the KDIGO guidelines.

Results: Exposure to ≥1 nephrotoxic medication occurred in 87% of infants. The most common exposures were gentamicin (86%), indomethacin (43%) and vancomycin (25%). There was an inverse linear relationship between birth weight and nephrotoxic medications received per day (R^2?=?0.169, p?<?0.001). Infants with AKI received more nephrotoxic medications per day than those who did not (0.24 versus 0.15; p?=?0.003).

Conclusions: VLBW infants are frequently exposed to nephrotoxic medications, receiving approximately two weeks of nephrotoxic medications before discharge or 1 for every 6?d of hospitalization. The greatest exposure occurred among the smallest, most immature infants and those who experienced AKI.     

Minimal change disease in pregnancy

Abstract

Background: New onset minimal change disease (MCD) is rare in pregnancy with the potential for serious complications including acute kidney injury (AKI).

Case: A case of MCD was diagnosed at 19 weeks gestation by renal biopsy. Within one month of starting steroids, the patient experienced normalization of renal function and resolution of nephrotic syndrome, although hemodialysis was needed as a temporizing measure.

Conclusion: The differential diagnosis for new onset proteinuria in pregnancy should include MCD. In selected cases, renal biopsy can be used to confirm diagnosis, and when indicated, hemodialysis should be instituted while awaiting a response to steroid therapy.     

Acute kidney injury and pneumothorax are risk factors for mortality in persistent pulmonary hypertension of the newborn in Thai neonates

Objectives: To describe the clinical characteristics, diagnostic methods, treatment modalities, and complications, and identify the mortality risk factors, of infants with short-term persistent pulmonary hypertension of the newborn (PPHN).

Methods: The clinical data of infants diagnosed with PPHN at Hat Yai Hospital from January 2010 to February 2014 were retrospectively reviewed. Cox proportional hazard regression analysis was performed to assess factors associated with mortality.

Results: The records of 119 infants were analyzed. Of these, 47 died giving an in-hospital mortality rate of 39.5%. The prevalence of PPHN (based on inborn births) was 2.8 per 1000 live births. The mean gestational age and birth weight were 39.1?±?1.6 weeks and 3044?±?563?g, respectively. Multivariate Cox regression analysis indicated that pneumothorax [adjusted hazard ratio (HR)?=?2.07 (95% CI 1.09–3.93)] and acute kidney injury [adjusted HR?=?2.99 (95% CI 1.59–5.61)] were factors associated independently with an increased risk for death, while infants who received total parenteral nutrition [adjusted HR?=?0.22 (95% CI 0.10–0.50)] had lower mortality.

Conclusion: A high mortality rate of PPHN was observed in this study. Significantly higher mortality was noted in infants complicated with pneumothorax and acute kidney injury.     

The effect of hemodynamically significant patent ductus arteriosus on acute kidney injury and systemic hypertension in extremely low gestational age newborns

Background: Acute kidney injury (AKI) in preterm neonates is becoming an increasingly recognized morbidity in the neonatal intensive care unit neonatal intensive care unit (NICU), yet its epidemiology, delineation and relation to numerous toxic exposures and common morbidities such as systemic hypertension is just evolving. With a frequency of the patent ductus arteriosus (PDA) as high as 70% in preterm infants born before 28-week gestation, the role of the hemodynamically significant PDA (hs-PDA) remains unclear.

Objective: To determine if AKI and systemic hypertension is more common in extremely low gestational age newborns (ELGAN) with hs PDA compared to ELGAN with no or non-hs PDA using modified AKIN and Neonatal Risk, Injury, Failure, Loss of Kidney Function, and End-stage (N-RIFLE) scoring systems.

Methods: This was a retrospective cohort study of infants ≤28 weeks gestational age born between 2010 and 2016 who had echocardiographic PDA evaluation completed for hemodynamical significance as well as serial serum creatinine and urine output measurement documented, needed for the two AKI scoring systems: modified AKIN (based on serial serum creatinine) and N-RIFLE (using urine output data). Blood pressure measurements and therapy were evaluated during the hospitalization and on the day of NICU discharge. Baseline characteristics and outcome variables were compared between the hs-PDA and no or non-hs PDA using unpaired t-tests for continuous variables and chi square tests for categorical data.

Results: One hundred fifty-one infants were eligible of which 110 had hs-PDA. Infants with hs-PDA were smaller (777 versus 867?g, p?=?.026), less mature (25.8 versus 26.4 weeks, p?=?.023) and had greater exposure to nephrotoxic drugs (14 versus 9.4 days, p?=?.001). Other clinical and demographic variables were similar between the two groups. The overall incidence of AKI was not different between the hs-PDA and no PDA or non-hs PDA groups when evaluated by the acute kidney injury network (AKIN) or N-RIFLE staging; however, preterm newborns with hs-PDA demonstrated a trend towards increased risk of AKI injury (12.7 versus 0.02%, p?=?.06). The N-RIFLE and AKIN scoring systems demonstrated very poor degree of agreement (kappa =?0.00853) in our study. There was no difference in the rates of hypertension during the hospitalization as well as on the day of NICU discharge.

Conclusion: Preterm neonates with hs-PDA had similar rates of AKI and hypertension as neonates with no or non-hs PDA.     

Neonatal renal cystic diseases

Purpose: Neonatal renal cystic diseases have a great impact on the morbidity and mortality of the affected neonates and infants. A good insight into the pathophysiology, diagnosis and treatment options of various neonatal renal cystic diseases aid in early diagnosis and intervention, thereby preventing complications.

Methods: PubMed search was done for articles on "neonatal renal cystic diseases" and relevant publications including reviews were considered for our article.

Results: Both hereditary and nonhereditary causes of cystic kidney diseases can result in severe morbidity and mortality. The main diagnostic modality is ultrasound imaging and most of the neonatal renal cystic diseases are detected during prenatal ultrasound screening. Commonly encountered neonatal renal cystic diseases are autosomal dominant polycystic kidney disease, autosomal recessive polycystic kidney disease and multicystic dysplastic kidney.

Conclusions: A thorough knowledge of various renal cystic diseases can be of extreme prognostic value. Physicians should be aware of the impact of early diagnosis and intervention on the lives of those affected. Further research about treatment of these diseases is ongoing and can result in breakthrough therapies for these patients.     

胎儿泌尿系统异常的宫内诊断与结局

目的:探讨胎儿泌尿系统异常的宫内诊断,动态观察其变化与结局,为优生优育提供理论参考及临床依据。方法:1995年1月至2003年10月开展前瞻性研究,对妊娠28周后,225例超声检查诊断为胎儿泌尿系异常者进行分类,观察结局。结果:225例中,单纯肾盂积水202例,占89.78%;多囊肾9例,占4.00%;肾盂积水伴输尿管积水8例,占3.65%;肾盂积水并输尿管积水及巨大膀胱2例,占0.89%;肾缺如4例,占1.78%。对单纯肾盂积水202例,每2～4周进行1次动态观察至分娩前,72.28%积水恢复至0级;观察至产后1周,积水恢复至0级者占92.08%;双侧输尿管积水、多囊肾、肾缺如共14例,终止妊娠13例,占92.86%,1例失访。结论:超声诊断胎儿泌尿系某些异常有较高的实用价值;不合并其他异常的单纯肾盂积水,可能与胎儿膀胱贮尿有关,是一种功能性、可逆性、良性变化;肾盂积水伴双侧输尿管积水者动态观察,积水加重者,多与泌尿系梗阻有关。双侧多囊肾及肾缺如,目前尚无特别治疗方法,一旦确诊应及早终止妊娠。