Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.
Pediatric and Infant Center for Acute Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
Nat Rev Nephrol. 2018 Nov;14(11):688-703. doi: 10.1038/s41581-018-0054-y.
Acute kidney injury (AKI) is a common and life-threatening complication in critically ill neonates. Gestational risk factors for AKI include premature birth, intrauterine growth restriction and low birthweight, which are associated with poor nephron development and are often the consequence of pre-gestational and gestational factors, such as poor nutritional status. Our understanding of how to best optimize renal development and prevent AKI is in its infancy; however, the identification of pre-gestational and gestational factors that increase the risk of adverse neonatal outcomes and the implementation of interventions, such as improving nutritional status early in pregnancy, have the potential to optimize fetal growth and reduce the risk of preterm birth, thereby improving kidney health. The overall risk of AKI among critically ill and premature neonates is exacerbated postnatally as these infants are often exposed to dehydration, septic shock and potentially nephrotoxic medications. Strategies to improve outcomes - for example, through careful evaluation of nephrotoxic drugs - may reduce the incidence of AKI and its consequences among this population. Management strategies and updated technology that will support neonates with AKI are greatly needed. Extremely premature infants and those who survive an episode of AKI should be screened for chronic kidney disease until early adulthood. Here, we provide an overview of our current understanding of neonatal AKI, focusing on its relationship to preterm birth and growth restriction. We describe factors that prevent optimal nephrogenesis during pregnancy and provide a framework for future explorations designed to maximize outcomes in this vulnerable population.
急性肾损伤（AKI）是危重新生儿的常见且危及生命的并发症。AKI 的妊娠风险因素包括早产、宫内生长受限和低出生体重，这些因素与肾单位发育不良有关，并且通常是妊娠前和妊娠期间因素的结果，例如营养状况不佳。我们对如何最好地优化肾脏发育和预防 AKI 的理解还处于起步阶段；然而，确定增加不良新生儿结局风险的妊娠前和妊娠期间因素，并实施干预措施，例如在妊娠早期改善营养状况，有可能优化胎儿生长并降低早产风险，从而改善肾脏健康。由于这些婴儿经常暴露于脱水、败血症性休克和潜在的肾毒性药物中，因此危重症和早产儿的 AKI 总体风险会在出生后加剧。改善结局的策略（例如，通过仔细评估肾毒性药物）可能会降低该人群 AKI 的发病率及其后果。非常早产儿和经历 AKI 发作的婴儿应在成年早期之前进行慢性肾脏病筛查。在这里，我们提供了对新生儿 AKI 的现有理解概述，重点关注其与早产和生长受限的关系。我们描述了在怀孕期间阻止最佳肾发生的因素，并为旨在使这个脆弱人群获得最佳结局的未来探索提供了框架。
