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Neonatal acute kidney injury: Evaluation, management, and prognosis

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 due to 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 diagnostic evaluation, management, and prognosis of neonatal AKI are presented in this topic review. The pathogenesis, etiology, presentation, and diagnosis of neonatal AKI are presented separately. (See "Acute kidney injury in children: Clinical features, etiology, evaluation, and diagnosis".)

IDENTIFYING THE UNDERLYING CAUSE

Overview — Once the diagnosis of neonatal AKI is made, further evaluation is focused towards identifying the underlying etiology so that management can be directed towards reversing the underlying cause if possible (table 1).

The evaluation consists of a directed history and physical examination including evaluation of the fluid status, renal imaging, and the use of a fluid challenge as a diagnostic and therapeutic measure. Laboratory tests such as serum potassium, bicarbonate, and phosphorus are not as useful in neonates compared with older patients because of the variable range of values due to functional and developmental immaturity of the neonatal kidney, which is affected by gestational age (GA) and postnatal age. (See "Neonatal acute kidney injury: Pathogenesis, etiology, clinical presentation, and diagnosis", section on 'Normal neonatal renal function'.)

Our general approach to the diagnostic evaluation encompasses the following (algorithm 1):

                              
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Literature review current through: Sep 2017. | This topic last updated: Oct 05, 2017.
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