Neonatal acute kidney injury: Pathogenesis, etiology, clinical presentation, and diagnosis
- Tej K Mattoo, MD, DCH, FRCP
Tej K Mattoo, MD, DCH, FRCP
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Wayne State University School of Medicine
- Section Editors
- Richard Martin, MD
Richard Martin, MD
- Section Editor — Neonatology
- Professor, Pediatrics, Reproductive Biology, and Physiology & Biophysics
- Case Western Reserve University School of Medicine
- F Bruder Stapleton, MD
F Bruder Stapleton, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Nephrology
- Professor and Chair, Department of Pediatrics
- University of Washington School of Medicine
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".)
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 a 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.
However, this definition most likely underestimates the prevalence of neonatal AKI because of the range of GFR due to the effects of gestational 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 (gestational age [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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- NORMAL NEONATAL RENAL FUNCTION
- Glomerular filtration rate
- Serum creatinine
- Time of first void and urine volume
- Tubular function
- - Urinary concentration
- - Sodium reabsorption
- - Bicarbonate reabsorption
- - Acid excretion
- PATHOGENESIS AND ETIOLOGY
- Prerenal disease
- - Risk factors
- Intrinsic renal disease
- - Tubular and interstitial disease
- - Renal vasculature disease
- Renal artery thrombosis
- Renal vein thrombosis
- - Glomerular disease
- Postrenal disease
- CLINICAL PRESENTATION
- At-risk asymptomatic patients
- Symptomatic patients
- Presentation due to other laboratory abnormalities
- Investigational urinary biomarkers
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS