St. John's Medical College Hospital, Bangalore, India.
J Matern Fetal Neonatal Med. 2022 Mar;35(6):1063-1069. doi: 10.1080/14767058.2020.1742319. Epub 2020 Mar 22.
Neonatal acute kidney injury (nAKI) poses unique challenges with diagnostic criteria specific to neonates evolving over time. Urine output (UOP) criterion has a special place in the diagnosis of nAKI although significant clarity on the ideal diagnostic threshold for UOP is not established. Risk factors peculiar to the tropical region for acute kidney injury (AKI) in neonates needs attention. It would be interesting to assess for kidney function in neonates who survived AKI during the dynamic phase of infancy.
To compare criteria of modified kidney disease improving global outcome (mKDIGO) and neonatal risk, injury, failure, loss, and end-stage criteria (nRIFLE) in diagnosing AKI in sick neonates; to study the risk factors for AKI and clinical outcomes at the end of neonatal ICU stay and during infancy.
This prospective study was conducted at a tertiary neonatal ICU that screened and staged sick neonates by applying mKDIGO and nRIFLE criteria. Risk factors were assessed and glomerular filtration rate was calculated by cystatin C in survivors of nAKI for 12 months post conception age.
nAKI was observed in 30% (49/163) of sick neonates. The mKDIGO (94%) detected a higher number of neonates with AKI compared to nRIFLE (49%). Based on only UOP, nRIFLE diagnosed a higher proportion of neonates with mild AKI compared to mKDIGO (29% versus 16%), respectively. Besides known risk factors, hypernatremic dehydration (18%) was an important risk factor for AKI. With 20% mortality, the risk of developing AKI was comparable using either mKDIGO or nRIFLE diagnostic criteria. At the end of infancy, mean cystatin C eGFR of neonates was 101.3 ± 29.2 ml/1.73 m/min.
In sick neonates, mKDIGO criteria performed better than nRIFLE in detecting AKI. However, the risk of mortality was comparable using either diagnostic criterion. Hypernatremic dehydration was an important risk factor for AKI and renal function of neonates following complete recovery of AKI was normal at the end of infancy.
新生儿急性肾损伤（nAKI）具有独特的挑战，其诊断标准是随着时间的推移而专门针对新生儿的。尿量（UOP）标准在 nAKI 的诊断中占有特殊地位，尽管 UOP 的理想诊断阈值尚未明确。急性肾损伤（AKI）在热带地区特有的危险因素需要引起关注。评估在婴儿期动态阶段幸存 AKI 的新生儿的肾功能将是有趣的。
比较改良肾脏病改善全球结局（mKDIGO）和新生儿风险、损伤、衰竭、损失和终末期（nRIFLE）标准在诊断患病新生儿 AKI 中的作用；研究 AKI 的危险因素和新生儿重症监护病房（NICU）结束时以及婴儿期的临床结局。
本前瞻性研究在一家三级新生儿重症监护病房进行，该病房通过应用 mKDIGO 和 nRIFLE 标准对患病新生儿进行筛查和分期。评估了风险因素，并在 nAKI 幸存者中计算了出生后 12 个月的肾小球滤过率（GFR），使用胱抑素 C。
30%（49/163）的患病新生儿发生了 nAKI。与 nRIFLE（49%）相比，mKDIGO（94%）检测到更多患有 AKI 的新生儿。仅基于 UOP，nRIFLE 诊断出患有轻度 AKI 的新生儿比例高于 mKDIGO（分别为 29%对 16%）。除了已知的危险因素外，高钠性脱水（18%）也是 AKI 的重要危险因素。死亡率为 20%，使用 mKDIGO 或 nRIFLE 诊断标准发生 AKI 的风险相当。在婴儿期末，患儿平均胱抑素 C eGFR 为 101.3±29.2ml/1.73m/min。
在患病新生儿中，mKDIGO 标准在检测 AKI 方面优于 nRIFLE。然而，使用任何诊断标准发生死亡率的风险相当。高钠性脱水是 AKI 的重要危险因素，在完全恢复 AKI 后，婴儿期末患儿的肾功能正常。
