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Neonatal acute kidney injury: Pathogenesis, etiology, clinical presentation, and diagnosis

Author
Tej K Mattoo, MD, DCH, FRCP
Section Editors
Richard Martin, MD
F Bruder Stapleton, MD
Deputy Editor
Melanie S Kim, MD

INTRODUCTION

Acute kidney injury (AKI), formerly referred to as acute renal failure (ARF), is defined as an acute reduction in kidney function that results in a decline in glomerular filtration rate (GFR), leading to retention of urea and other nitrogenous waste products and loss of fluid, electrolyte, and acid-base regulation. AKI is an important contributing factor to the morbidity and mortality of critically ill neonates.

The pathogenesis, etiology, presentation, and diagnosis of neonatal AKI is presented in this topic review. The diagnostic evaluation, management, and prognosis of neonatal AKI in children are presented separately. (See "Neonatal acute kidney injury: Evaluation, management, and prognosis".)

DEFINITION

AKI is typically defined as a decrease in glomerular filtration rate (GFR), which is traditionally defined by an elevated serum creatinine (SCr) or a rise in SCr from baseline. Clinically, neonatal AKI has been most commonly defined as an SCr greater than 1.5 mg/dL (133 micromol/L) or an increase of at least 0.2 to 0.3 mg/dL (17 to 27 micromol/L) per day from a previous lower value. Of note, the SCr value at birth reflects the maternal SCr and normally decreases over time. (See 'Normal neonatal renal function' below.)

However, these definitions most likely underestimate the prevalence of neonatal AKI because of the range of GFR due to the effects of gestational age (GA) and postnatal age. Efforts have been made to reach a more accurate consensus definition based on normative data; however, it has been challenging to obtain this information, especially in very preterm infants (GA <32 weeks).

Despite these limitations, definitions of neonatal AKI used in research studies have been published that rely on SCr, including the following:

                            
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Literature review current through: Oct 2017. | This topic last updated: Oct 05, 2017.
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References
Top
  1. Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr 2012; 24:191.
  2. Selewski DT, Charlton JR, Jetton JG, et al. Neonatal Acute Kidney Injury. Pediatrics 2015; 136:e463.
  3. Bruel A, Rozé JC, Flamant C, et al. Critical serum creatinine values in very preterm newborns. PLoS One 2013; 8:e84892.
  4. Bruel A, Rozé JC, Quere MP, et al. Renal outcome in children born preterm with neonatal acute renal failure: IRENEO-a prospective controlled study. Pediatr Nephrol 2016; 31:2365.
  5. Vieux R, Hascoet JM, Merdariu D, et al. Glomerular filtration rate reference values in very preterm infants. Pediatrics 2010; 125:e1186.
  6. Gubhaju L, Sutherland MR, Horne RS, et al. Assessment of renal functional maturation and injury in preterm neonates during the first month of life. Am J Physiol Renal Physiol 2014; 307:F149.
  7. Guignard JP, Drukker A. Why do newborn infants have a high plasma creatinine? Pediatrics 1999; 103:e49.
  8. Boer DP, de Rijke YB, Hop WC, et al. Reference values for serum creatinine in children younger than 1 year of age. Pediatr Nephrol 2010; 25:2107.
  9. Bateman DA, Thomas W, Parravicini E, et al. Serum creatinine concentration in very-low-birth-weight infants from birth to 34-36 wk postmenstrual age. Pediatr Res 2015; 77:696.
  10. Clark DA. Times of first void and first stool in 500 newborns. Pediatrics 1977; 60:457.
  11. FISHER DA, PYLE HR Jr, PORTER JC, et al. CONTROL OF WATER BALANCE IN THE NEWBORN. Am J Dis Child 1963; 106:137.
  12. Joppich R, Scherer B, Weber PC. Renal prostaglandins: relationship to the development of blood pressure and concentrating capacity in pre-term and full term healthy infants. Eur J Pediatr 1979; 132:253.
  13. CALCAGNO PL, RUBIN MI, WEINTRAUB DH. Studies on the renal concentrating and diluting mechanisms in the premature infant. J Clin Invest 1954; 33:91.
  14. Edelmann CM, Soriano JR, Boichis H, et al. Renal bicarbonate reabsorption and hydrogen ion excretion in normal infants. J Clin Invest 1967; 46:1309.
  15. Manz F, Kalhoff H, Remer T. Renal acid excretion in early infancy. Pediatr Nephrol 1997; 11:231.
  16. Koralkar R, Ambalavanan N, Levitan EB, et al. Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res 2011; 69:354.
  17. Carmody JB, Swanson JR, Rhone ET, Charlton JR. Recognition and reporting of AKI in very low birth weight infants. Clin J Am Soc Nephrol 2014; 9:2036.
  18. Maqsood S, Fung N, Chowdhary V, et al. Outcome of extremely low birth weight infants with a history of neonatal acute kidney injury. Pediatr Nephrol 2017; 32:1035.
  19. Hentschel R, Lödige B, Bulla M. Renal insufficiency in the neonatal period. Clin Nephrol 1996; 46:54.
  20. Normal kidney development. In: Pediatric Kidney Disease, 2nd ed, Edelman CM Jr (Ed), Little, Brown and Company, Boston 1992. p.3.
  21. Arant BS. Neonatal adjustments to extrauterine life. In: Pediatric Kidney Disease, 2nd ed, Edelman CM (Ed), Little, Brown and Company, Boston 1992. p.1015.
  22. Bueva A, Guignard JP. Renal function in preterm neonates. Pediatr Res 1994; 36:572.
  23. Tóth-Heyn P, Drukker A, Guignard JP. The stressed neonatal kidney: from pathophysiology to clinical management of neonatal vasomotor nephropathy. Pediatr Nephrol 2000; 14:227.
  24. Awazu M, Hunley TE, Kon V. Pathophysiology of acute renal failure in the neonatal period. In: Fetal and Neonatal Physiology, 2nd ed, Polin RA, Fox WW (Eds), Saunders, Philadelphia 1998. p.1691.
  25. Khan RZ, Badr KF. Endotoxin and renal function: perspectives to the understanding of septic acute renal failure and toxic shock. Nephrol Dial Transplant 1999; 14:814.
  26. Badr KF. Sepsis-associated renal vasoconstriction: potential targets for future therapy. Am J Kidney Dis 1992; 20:207.
  27. Hanna MH, Askenazi DJ, Selewski DT. Drug-induced acute kidney injury in neonates. Curr Opin Pediatr 2016; 28:180.
  28. Vieux R, Fresson J, Guillemin F, Hascoet JM. Perinatal drug exposure and renal function in very preterm infants. Arch Dis Child Fetal Neonatal Ed 2011; 96:F290.
  29. Goetzman BW, Stadalnik RC, Bogren HG, et al. Thrombotic complications of umbilical artery catheters: A clinical and radiographic study. Pediatrics 1975; 56:374.
  30. Boo NY, Wong NC, Zulkifli SS, Lye MS. Risk factors associated with umbilical vascular catheter-associated thrombosis in newborn infants. J Paediatr Child Health 1999; 35:460.
  31. Muñoz-Arizpe R, Walsh RF, Edge W. Obstructive aortic and renal thrombosis in the newborn--spontaneous recovery. Pediatr Nephrol 1992; 6:190.
  32. Ellis D, Kaye RD, Bontempo FA. Aortic and renal artery thrombosis in a neonate: recovery with thrombolytic therapy. Pediatr Nephrol 1997; 11:641.
  33. Flynn JT. Neonatal hypertension: diagnosis and management. Pediatr Nephrol 2000; 14:332.
  34. Bökenkamp A, von Kries R, Nowak-Göttl U, et al. Neonatal renal venous thrombosis in Germany between 1992 and 1994: epidemiology, treatment and outcome. Eur J Pediatr 2000; 159:44.
  35. Durkan AM, Alexander RT. Acute kidney injury post neonatal asphyxia. J Pediatr 2011; 158:e29.
  36. Timovska SN, Cekovska S, Tosheska-Trajkovska K. Acute Kidney Injury in Newborns. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2015; 36:83.
  37. Askenazi DJ, Montesanti A, Hunley H, et al. Urine biomarkers predict acute kidney injury and mortality in very low birth weight infants. J Pediatr 2011; 159:907.
  38. Mussap M, Degrandi R, Fravega M, Fanos V. Acute kidney injury in critically ill infants: the role of urine Neutrophil Gelatinase-Associated Lipocalin (NGAL). J Matern Fetal Neonatal Med 2010; 23 Suppl 3:70.
  39. Elmas AT, Tabel Y, Elmas ON. Serum cystatin C predicts acute kidney injury in preterm neonates with respiratory distress syndrome. Pediatr Nephrol 2013; 28:477.
  40. Li Y, Fu C, Zhou X, et al. Urine interleukin-18 and cystatin-C as biomarkers of acute kidney injury in critically ill neonates. Pediatr Nephrol 2012; 27:851.
  41. Saeidi B, Koralkar R, Griffin RL, et al. Impact of gestational age, sex, and postnatal age on urine biomarkers in premature neonates. Pediatr Nephrol 2015; 30:2037.