Acute kidney injury in the newborn – a challenge for the medical team

Abstract

Acute kidney injury (AKI) is the sudden deterioration of kid­ney function, which causes a decrease in the glomerular filtration rate. Neonatal acute kidney injury is common in neonates ad­mit­ted to neonatal intensive care units (NICU) and is a major fac­tor for neonatal mortality and morbidity. The incidence of AKI is 6-24% in NICU neonates, 25% in oliguric forms, 60% in non-oliguric forms and 15% in anuric forms. AKI occurs more frequen­tly in very low birth weight babies. The diagnosis in­volves family and perinatal history, physical examination of the newborn, biochemical examinations, blood gas analysis, he­ma­to­logical examination, urine measurements, imaging stu­dies and histological studies. Prophylaxis is preferable to cu­ra­tive treatment, and involves early detection of risk factors, fe­tal ultrasound to detect renal malformations, prevention of de­creased renal blood flow or intravascular blood volume by pro­phy­lac­tic administration of dopamine and furosemide or man­ni­tol, along with avoidance of nephrotoxic drugs during preg­nan­cy. Neonatal dialysis in newborns and children who have reduced muscle mass is done at lower values of serum crea­ti­nine. Hemodialysis has been replaced by peritoneal dia­lysis and hemodiafiltration, the technique of choice for the treatment of vascular overload. Peritoneal dialysis is con­tra­in­di­ca­ted in newborns with respiratory distress, shock, pe­ri­to­ni­tis or ulceronecrotic enterocolitis. Knowing and using stan­dar­dized definitions and staging of AKI in newborn contribute to a more efficient approach to the patient by the complex me­di­cal team.