Chirico Valeria, Lacquaniti Antonio, Tripodi Filippo, Conti Giovanni, Marseglia Lucia, Monardo Paolo, Gitto Eloisa, Chimenz Roberto
Pediatric Nephrology and Dialysis Unit, University Hospital "G. Martino", 98124 Messina, Italy.
Nephrology and Dialysis Unit, Papardo Hospital, 98158 Messina, Italy.
J Clin Med. 2024 Jun 13;13(12):3446. doi: 10.3390/jcm13123446.
Acute kidney injury (AKI) is associated with long-term consequences and poor outcomes in the neonatal intensive care unit. Its precocious diagnosis represents one of the hardest challenges in clinical practice due to the lack of sensitive and specific biomarkers. Currently, neonatal AKI is defined with urinary markers and serum creatinine (sCr), with limitations in early detection and individual treatment. Biomarkers and risk factor scores were studied to predict neonatal AKI, to early identify the stage of injury and not the damage and to anticipate late increases in sCr levels, which occurred when the renal function already began to decline. Sepsis is the leading cause of AKI, and sepsis-related AKI is one of the main causes of high mortality. Moreover, preterm neonates, as well as patients with post-neonatal asphyxia or after cardiac surgery, are at a high risk for AKI. Critical patients are frequently exposed to nephrotoxic medications, representing a potentially preventable cause of AKI. This review highlights the definition of neonatal AKI, its diagnosis and new biomarkers available in clinical practice and in the near future. We analyze the risk factors involving patients with AKI, their outcomes and the risk for the transition from acute damage to chronic kidney disease.
急性肾损伤（AKI）与新生儿重症监护病房的长期后果及不良预后相关。由于缺乏敏感且特异的生物标志物，其早期诊断是临床实践中最具挑战性的难题之一。目前，新生儿AKI通过尿液标志物和血清肌酐（sCr）进行定义，在早期检测和个体化治疗方面存在局限性。人们对生物标志物和风险因素评分进行了研究，以预测新生儿AKI，早期识别损伤阶段而非损伤情况，并预测sCr水平的后期升高，这种升高发生在肾功能已经开始下降时。脓毒症是AKI的主要病因，脓毒症相关的AKI是高死亡率的主要原因之一。此外，早产儿以及新生儿窒息后或心脏手术后的患者发生AKI的风险很高。危重症患者经常接触肾毒性药物，这是AKI一个潜在可预防的病因。本综述重点介绍了新生儿AKI的定义、诊断以及临床实践中现有的和不久将来可用的新生物标志物。我们分析了涉及AKI患者的风险因素、其预后以及从急性损伤转变为慢性肾病的风险。
