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

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


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 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: Nov 2017. | This topic last updated: Oct 05, 2017.
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