Особливості ренального кровотоку при гострому пошкодженні нирок у недоношених новонароджених дітей з гемодинамічно значущою відкритою артеріальною протокою

Abstract

Hemodynamically significant patent ductus arteriosus (HSPDA) in premature infants leads to renal hypoperfusion due to the phenomenon of «stealing» of the systemic circulation, which can contribute to the development of acute kidney injury (AKI). The use of ultrasound Doppler sonography of the renal vessels can be effective in assessing renal blood flow and in the early diagnosis of acute renal failure. Purpose — to assess the prognostic significance of the state of renal blood flow in the first day of life in premature infants with HSPDA in the early diagnosis of AKI. Materials and methods. We examined 40 preterm infants (gestational age 29–36 weeks) with HSPDA. Distribution of the examined patients: the group with AKI — 23 children, the group without AKI — 17 children. The observation period was 10 days. The patients underwent echocardiography with Doppler analysis using a broadband microconvex probe with a frequency of 5–8 MHz (TOSHIBA Nemso XG) at 5–11 hours of life. Color Doppler ultrasound scanning of renal vessels was performed on the first, third and tenth days of life. The parameters of blood flow in the main renal and interlobar renal arteries were studied: peak systolic velocity (PSV) and end diastolic velocity (EDV) of blood flow, resistance index (RI). Diagnosis and stratification of AKI severity met the KDIGO neonatal modification criteria. Results. On the third to fifth day of life, AKI was diagnosed in 23 (57.5%) children, but already in the first day of life, compared with patients without AKI, a significant decrease in PSV parameters of blood flow in the main renal artery was noted (20.6±5.87 cm/sec versus 25.4±6.17 cm/sec in children without AKI, p<0.02). In addition, the main changes in the first day of life in patients with AKI were revealed at the level of the interlobar renal artery, namely: a decrease in PSV blood flow (11.10±3.329 cm/sec versus 18.48±3.014 cm/sec in children without AKI, p<0.001) and EDV of blood flow (2.83±2.063 cm/sec versus 6.16±2.447 cm/sec in children without AKI, p<0.001), increased RI (0.758±0.137 versus 0.666±0.1216 in children without AKI, p<0.02). On the third day of life at AKI, there was a disorder in the parameters of blood flow in the interlobaric renal artery, the value of which on the tenth day of life did not differ from the parameters of children without AKI. Conclusions. In premature infants with HSPDA, who were diagnosed with AKI on the third to fifth day of life, in the first day of life, there is a decrease in PSV blood flow parameters in the main renal artery, changes in blood flow in the interlobar renal artery, namely: a decrease in PSV and EDV blood flow, an increase in RI. Thus, the assessment of the state of blood flow in the interlobar renal artery on the first day of life in premature infants with HSPDA is of diagnostic value for the timely determination of the risk group for AKI. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: premature infants, patent ductus arteriosus, renal blood flow, acute kidney injury.