Acute kidney injury in neonatal intensive care unit and the significance of nRIFLE criteria on diagnosis and prognosis

Abstract

Objectives: The objective of this study is to identify factors that affect the severity of acute kidney injury (AKI) using neonatal RIFLE (Risk, Injury, Failure, Loss of function, End-stage kidney disease) criteria; to identify the impact of these criteria and the factors on mortality rates and to determine the one-year clinical outcome.

Methods: Five hundred and thirty-two inpatients who were admitted to Gazi University, Faculty of Medicine, Neonatal Intensive Care Unit (NICU) between 2006 and 2016 have been examined retrospectively.

Results: Acute kidney injury developed in the first month of life in 85 (16%) patients. Thirty-nine (7.35%) of the cases were term and 46 (8.65%) were preterm. Among these patients, 33 (38.8%) were in the risk group, 18 (21%) in the injury group, and 34 (40%) in the failure group. Metabolic acidosis and edema were the most commonly seen findings as acute kidney injury scores increased. According to the neonatal RIFLE (nRIFLE) criteria, the severity of AKI was significantly correlated (p < 0.05) with metabolic acidosis (71%) and edema (50.5%). There was a positive correlation between urinary output and pH, bicarbonate, glomerular filtration rate, and sodium values in patients with AKI, while a negative correlation between urinary output and BUN, creatinine, potassium, phosphorus, and uric acid was found. Regarding the nRIFLE criteria, the frequency of hyponatremia and hyperpotassemia was increased as the AKI severity score was increasing (p < 0.05). The mortality rate was 54% in the newborn period and factors that significantly affect mortality were the need for mechanical ventilation, sepsis, nephrotoxicity, and acidosis (p < 0.05).

Conclusions: The nRIFLE criteria based on urinary output is a guide for clinicians to diagnose AKI. There is a need to work on new markers in future studies.

Keywords

• Acute kidney injury
• risk factors
• nRIFLE
• newborn

References

1. 1. Ottonello G, Dessì A, Neroni P, Trudu ME, Manus D, Fanos V. Acute kidney injury in neonatal age. J Pediatr Neonat Individual Med. 2014;3(2):e030246. doi: 10.7363/030246.
2. 2. Andreoli SP. Renal failure in the neonate. In: Oh W, Guignard JP, Baumgart S, eds. Nephrology and Fluid/Electrolyte Physiology. 1st ed. Saunders Elsevier Philadephia; 2008:pp.285-305.
3. 3. Jetton JG, Askenazi DJ. Acute kidney injury in the neonate. Clin Perinatol. 2014;41(3):487-502. doi: 10.1016/j.clp.2014.05.001.
4. 4. Bezerra CT, Vaz Cunha LC, Libório AB. Defining reduced urine output in neonatal ICU: importance for mortality and acute kidney injury classification. Nephrol Dial Transplant. 2013;28(4):901-909. doi: 10.1093/ndt/gfs604.
5. 5. Ricci Z, Ronco C. Neonatal RIFLE. Nephrol Dial Transplant. 2013;28(9):2211-2214. doi: 10.1093/ndt/gft074.
6. 6. Selewski DT, Charlton JR, Jetton JG, et al. Neonatal acute kidney injury. Pediatrics. 2015;136(2):e463-473. doi: 10.1542/peds.2014-3819.
7. 7. Askenazi D, Smith LB, Furth S, Warady BA. Acute kidney injury and chronic kidney disease. In: Gleason CA, Devaskar SU eds. Avery’s Disease of the Newborn. 9th ed. Saunders Elsevier Philadelphia; 2012: pp. 1281-300.
8. 8. Askenazi DJ, Montesanti A, Hunley H, Koralkar R, Pawar P, Shuaib F, et al. Urine biomarkers predict acute kidney injury and mortality in very low birth weight infants. J Pediatr. 2011;159:907-12. e1.

9. 9. Stojanović V, Barišić N, Milanović B, Doronjski A. Acute kidney injury in preterm infants admitted to a neonatal intensive care unit. Pediatr Nephrol. 2014;29(11):2213-2220. doi: 10.1007/s00467-014-2837-0.
10. 10. Cataldi L, Leone R, Moretti U, et al. Potential risk factors for the development of acute renal failure in preterm newborn infants: a case-control study. Arch Dis Child Fetal Neonatal Ed. 2005;90(6):F514-519. doi: 10.1136/adc.2004.060434.
11. 11. Zappitelli M, Selewski DT, Askenazi DJ. Nephrotoxic medication exposure and acute kidney injury in neonates. Neoreviews. 2012;13(7):e420-e427. doi: 10.1542/neo.13-7-e420
12. 12. Ebru Özcan K. Yenidoğan yoğun bakım ünitesinde gözlenen olgularda akut böbrek hasarı ve pRIFLE kriterlerinin tanı ve prognozdaki önemi. TC. Başkent Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Uzmanlık Tezi, 2013.
13. 13. Askenazi DJ, Koralkar R, Hundley HE, Montesanti A, Patil N, Ambalavanan N. Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate. Pediatr Nephrol. 2013;28(4):661-666. doi: 10.1007/s00467-012-2369-4.
14. 14. Mathur NB, Agarwal HS, Maria A. Acute renal failure in neonatal sepsis. Indian J Pediatr. 2006;73(6):499-502. doi: 10.1007/BF02759894.
15. 15. Bolat F, Comert S, Bolat G, et al. Acute kidney injury in a single neonatal intensive care unit in Turkey. World J Pediatr. 2013;9(4):323-329. doi: 10.1007/s12519-012-0371-3.
16. 16. Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D. Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res. 2011;69(4):354-358. doi: 10.1203/PDR.0b013e31820b95ca.
17. 17. Moghal NE, Embleton ND. Management of acute renal failure in the newborn. Semin Fetal Neonatal Med. 2006;11(3):207-213. doi: 10.1016/j.siny.2006.01.007.
18. 18. Viswanathan S, Manyam B, Azhibekov T, Mhanna MJ. Risk factors associated with acute kidney injury in extremely low birth weight (ELBW) infants. Pediatr Nephrol. 2012;27(2):303-11. doi: 10.1007/s00467-011-1977-8.