Abstract
Acute kidney injury is associated with mortality of very low birth weight infants and reduces their survival regardless of other factors. The kidneys in the extremely preterm infants are very immature and susceptible to environmental factors. Clinical conditions and medications are risk factors for acute kidney injury in these patients. Nephrolithiasis in preterm infants is an extremely rare phenomenon that usually manifests as a complication of nephrocalcinosis.This is a case report that describes several episodes of acute kidney injury in the first two months of age in an extremely low birth weight infant with kidney stones in the background. The main causes that led to acute kidney injury in this patient were persistent ductus arteriosus, sepsis and captopril. At one month of age, ultrasound detected calcinates in the right kidney. Within two weeks a large number of linear stones formed across the collecting duct system. Small calcinates still remained in the right kidney when the girl was half a year of the corrected age.The evaluation of a neonate who develops acute kidney injury requires a systematic approach. Early identification of the emerging risk factors and prevention of nephrolithiasis along with effective treatment can reduce the risk of developing acute kidney injury in very low birth weight infants.
Highlights
Adaptation of extremely-low-birth-weight (ELBW) infants requires long-term treatment of diseases caused by prematurity as well as of congenital and acquired diseases
The kidney stones were treated with potassium citrate prescribed by a pediatric nephrologist. Before she was discharged from the hospital, smaller changes were observed in the right kidney in the repeated ultrasonography of the urinary tract: a large number of small calcinates, which in some places merged into linear calcinates, were observed
In the case of acute kidney injury of VLBW infants, both the treatment and the injury itself increase the risk of morbidity during first months of life
Summary
Adaptation of extremely-low-birth-weight (ELBW) infants requires long-term treatment of diseases caused by prematurity as well as of congenital and acquired diseases. On day 52 of life, a urinary tract infection complicated the condition of the infant. Kidney injury was obvious as a result of the following features: hyperkalemia (to 8.8 mmol/L), elevated creatinine (173 μmol/L, the normal value is 15–37 μmol/L) and urea (8.98 mmol/L, the normal value is 1.7–8.3 mmol/L) levels in the blood. Blood creatinine level decreased after 24 hours to 71 μmol/L, and returned to its baseline values (29 μmol/L) after two days. The kidney stones were treated with potassium citrate prescribed by a pediatric nephrologist Before she was discharged from the hospital, smaller changes were observed in the right kidney in the repeated ultrasonography of the urinary tract: a large number of small calcinates, which in some places merged into linear calcinates, were observed (see Fig. 2). Small calcinates still remained in the right kidney and hypercalciuria was found in the urine when the girl was half a year of the corrected age
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