Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Pediatrics, University of Washington, Seattle, WA, USA.
Pediatr Nephrol. 2021 Nov;36(11):3607-3619. doi: 10.1007/s00467-021-04977-1. Epub 2021 Feb 17.
Neonatal acute kidney injury (AKI) is increasingly recognized as a common complication in critically ill neonates. Over the last 5-10 years, there have been significant advancements which have improved our understanding and ability to care for neonates with kidney disease. A variety of factors contribute to an increased risk of AKI in neonates, including decreased nephron mass and immature tubular function. Multiple factors complicate the diagnosis of AKI including low glomerular filtration rate at birth and challenges with serum creatinine as a marker of kidney function in newborns. AKI in neonates is often multifactorial, but the cause can be identified with careful diagnostic evaluation. The best approach to treatment in such patients may include diuretic therapies or kidney support therapy. Data for long-term outcomes are limited but suggest an increased risk of chronic kidney disease (CKD) and hypertension in these infants. We use a case-based approach throughout this review to illustrate these concepts and highlight important evidence gaps in the diagnosis and management of neonatal AKI.
新生儿急性肾损伤（AKI）越来越被认为是危重新生儿的常见并发症。在过去的 5-10 年中，已经有了重大进展，提高了我们对患有肾脏疾病的新生儿的理解和护理能力。多种因素导致新生儿 AKI 的风险增加，包括肾单位数量减少和肾小管功能不成熟。多种因素使 AKI 的诊断变得复杂，包括出生时肾小球滤过率低以及血清肌酐作为新生儿肾功能标志物的挑战。新生儿 AKI 通常是多因素的，但通过仔细的诊断评估可以确定病因。此类患者的最佳治疗方法可能包括利尿剂治疗或肾脏支持治疗。关于长期预后的数据有限，但表明这些婴儿患慢性肾脏病（CKD）和高血压的风险增加。在本综述中，我们采用基于病例的方法来阐明这些概念，并强调新生儿 AKI 的诊断和管理方面存在的重要证据差距。
