新生儿缺氧缺血性脑病合并急性肾损伤的危险因素及预后评估
Evaluation of risk factors and outcomes of neonates with hypoxic ischemic encephalopathy and acute kidney injury.
作者信息
Todo Bom Costa Sara, Costa Reis Patrícia, Mendes Graça André
机构信息
Neonatology Service, Pediatrics Department, Hospital Santa Maria, Unidade Local de Saúde Santa Maria, Lisbon, Portugal.
Hospital CUF Descobertas, Lisbon, Portugal.
出版信息
J Perinatol. 2025 Aug 4. doi: 10.1038/s41372-025-02379-x.
OBJECTIVES
To assess risk factors for acute kidney injury (AKI) in neonates with hypoxic ischemic encephalopathy (HIE) using KDIGO and Gupta definitions, and evaluate long-term kidney function.
METHODS
Retrospective study including 72 neonates with HIE and prospective evaluation of long-term kidney health data of 33 survivors.
RESULTS
AKI was detected in 49% using KDIGO and 32% using Gupta's definition. KDIGO-defined AKI correlated with thrombocytopenia, low pH, transfusions need, nephrotoxic drugs, and furosemide use (p < 0.05). The Gupta definition showed additional associations with hypotension, cardiac dysfunction, and death (p < 0.05). In a logistic regression model, both definitions linked AKI to nephrotoxic drug exposure and transfusions. Follow-up assessments revealed elevated blood pressure in 12%, hyperfiltration in 18%, and proteinuria in 6% of survivors.
CONCLUSIONS
The Gupta definition may help identify AKI in an additional number of neonates with HIE. Long-term monitoring is essential for the early detection of kidney dysfunction.
目的
使用KDIGO和古普塔（Gupta）的定义评估缺氧缺血性脑病（HIE）新生儿急性肾损伤（AKI）的危险因素，并评估长期肾功能。
方法
回顾性研究纳入72例HIE新生儿，并对33例幸存者的长期肾脏健康数据进行前瞻性评估。
结果
使用KDIGO定义检测到49%的患儿发生AKI，使用古普塔定义检测到32%。KDIGO定义的AKI与血小板减少、低pH值、输血需求、肾毒性药物和呋塞米使用相关（p<0.05）。古普塔定义还显示与低血压、心脏功能障碍和死亡相关（p<0.05）。在逻辑回归模型中，两种定义均将AKI与肾毒性药物暴露和输血联系起来。随访评估显示，12%的幸存者血压升高，18%的幸存者出现超滤，6%的幸存者出现蛋白尿。
结论
古普塔定义可能有助于识别更多HIE新生儿中的AKI。长期监测对于早期发现肾功能障碍至关重要。
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