Kidney Injury In Newborns Research Articles

Cardiac surgery-associated acute kidney injury in newborns: A meta-analysis

<b>Introduction</b>: Acute kidney injury is a common complication following pediatric heart surgery, and it has been linked to an increased risk of morbidity and fatality.<br /> <b>Methods</b>: The PubMed and Medline databases were combed for relevant research until May 2022. The terms [Cardiac surgery] AND [acute renal injury] AND [newborns OR children OR neonates] AND [randomized control studies OR randomized control trials] were used as search criteria. The studies that met the inclusion criteria were considered qualified using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.<br /> <b>Results</b>: A total of 2,941 newborns or children were enrolled in 14 studies, with 931 developing acute renal damage. 2,095 of the enrolled infants and children received steroid, aminophylline, dexmedetomidine, and acetaminophen therapies. In seven studies, the odds ratio for steroids was not significantly different from control. In contrast, two studies comparing aminophylline to a control group found no statistically significant change. Two studies found no significant difference in dexmedetomidine therapy compared to control. Three trials, however, found a significant difference between the acetaminophen treatment and control groups.<br /> <b>Conclusion</b>: Acetaminophen was linked to a decreased risk of postoperative acute renal injury, while steroids had no benefit and aminophylline treatment could be justified.

Early Predictor of Acute Kidney Injury in Newborns with Perinatal Asphyxia

AbstractAcute kidney injury (AKI) is an independent risk factor for neonatal death. Since neonatal early renal injury usually has no specific clinical symptoms, many AKI cases are often missed the best time of early intervention if there is no relevant examination. Perinatal asphyxia (PA) can lead to AKI. The study aimed to assess efficacy of serum cystatin C (CystC) in early prediction of AKI in full-term neonates with PA. The study was conducted at the neonatal intensive care unit, Assiut University Children Hospital from January 2019 to January 2021. Seventy full-term neonates with documented PA were enrolled in the study. Baseline laboratory data and serum CystC levels were assessed. Out of those 70 neonates with PA, 21 (30%) developed AKI, while 49 (70%) neonates did not develop AKI. Majority of non-AKI group had stage-I hypoxic-ischemic encephalopathy (HIE) (61.2%), while majority of AKI had stage-III HIE (61.9%). A significantly higher serum CystC level was found among AKI group than those without AKI (1.50 ± 0.12 vs. 0.90 ± 0.14, p < 0.001). The predictors for AKI among neonates with PA were low birth weight, serum CystC levels, hypotension, and stage-III HIE. Serum CystC has 94.3% overall accuracy for prediction of AKI. In conclusion, AKI in neonates with PA is common. CystC is a promising biomarker in early prediction of AKI in such cases. Future studies are warranted to confirm these findings.

Assessment of the diagnostic ability of RIFLE classification and neutrophil gelatinase-associated lipocalin biomarker in detecting acute kidney injury in newborns at the intensive care unit

Introduction/Objective. This study was designed to demonstrate the association of the RIFLE classification and neutrophil gelatinase-associated lipocalin (NGAL) in predicting of newborns with acute kidney injury (AKI). Methods. This was a prospective study. We included 100 newborns suspected of having a kidney injury. These newborns were admitted to the intensive care unit (ICU) at the University Clinic of Pediatrics from the period of two years. The severity of the disease was determined by RIFLE classification. The biochemical marker NGAL was included in this study because it is an early biomarker of AKI in newborns. The statistical processing of the material was by methods of descriptive statistics. Results. The prevalence rate of AKI was 6.25%, but according to the RIFLE classification the prevalence was 8.7%. According to RIFLE classification, we reported ?risk? in 36%, ?injury? in 50% and ?failure? in 14% of newborns with AKI. In newborns with perinatal asphyxia, kidney injury was seen in 34% and 30%, making perinatal asphyxia the most common predisposing factor. The difference in average value of the score for neonatal acute physiology with perinatal extension in newborns with AKI and the control group without AKI was confirmed significant (p < 0.001). Also, there was a significant difference (p < 0.001) between serum creatinine and urinary NGAL values, on the day they were admitted to the ICU. Conclusion. In newborns hospitalized in the ICU, AKI is a serious condition. We could identify kidney injury and follow up the progression of the disease by using RIFLE classification. The need for early diagnosis of kidney injury, in a period when the disease is not clinically manifest, in the first hours of its occurrence, is provided by NGAL.

Early Detection of Acute Kidney Injury in Newborns with Respiratory Distress Syndrome by measurement of serum cystatin c

Acute kidney injury (AKI) is an important contributing factor to the morbidity and mortality of critically ill neonates. Neonates with respiratory distress syndrome (RDS) are at increased risk of AKI due to exposure to hypoxia, acidosis, hypovolemia, vasopressors and mechanical, the aim of the study is to compare serum cystatin C levels (sCysC) in preterm neonates with respiratory distress syndrome (RDS) with a control group and to evaluate the role of serum cystatin c in prediction of acute kidney injury in preterm with RDS a prospective study (case-control) Conveyed crazy from february 2019 on january 2020. The contemplate might have been led on 62 neonates starting with the neonatal emergency unit units (NICUs) about Benha college healing centers Furthermore Benha protection Hospital, might have been subdivided into; one assembly (I): Which incorporated 34healthy control preterm neonates without RDS ,Group (II): Which included 22 preterm neonates with RDS without AKI Furthermore one assembly (III): Which incorporated 6 preterm neonates with RDS & AKI, there were six neonates with AKI and 22 neonates without AKI Throughout those 1st 7 days In view of KDIGO definition about AKI, sCysC levels at 3rd day about life were essentially higher over neonates with RDS Be that as no AKI and neonates in the control group, serum creatinine (sCr) qualities during 3rd day about an aggregation demonstrated no noteworthy distinction the middle of the individuals with RDS for AKI, RDS What's more no AKI or control groups, sCysC could be utilized as a free predictor of AKI for preterm neonates with RDS.

Can urinary biomarkers predict acute kidney injury in newborns with critical congenital heart disease?

Background/aim Congenital heart disease (CHD) is the most common congenital malformation group and is the leading cause of newborn mortality in developed countries. Most of the infants with CHD develop preoperative or postoperative acute kidney injury (AKI). Acute kidney injury may develop before the serum creatinine rise and oliguria. Urinary biomarkers such as kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), interleukin (IL)-18, and cystatin C may predict AKI in patients with critical CHD (CCHD) before the serum creatinine rise. In this study, we aimed to determine the AKI incidence among newborn patients with CCHD and investigate the predictivity of urinary biomarkers for AKI. Materials and methods Newborns with a gestational age >34 weeks and birth weight >1500 g with a diagnosis of CCHD were enrolled in the study. Blood and urine samples were collected at birth, during the first 24–48 h, and in the preoperative and postoperative periods. Results A total of 53 CCHD patients requiring surgery during the neonatal period were enrolled in the study. The 24–48 h KIM-1 levels of the cases with exitus were higher (P = 0.007). The 24–48 h cystatin C and preoperative NGAL levels were higher in patients with postoperative AKI (P = 0.02). ConclusionIn newborns with CCHD, high KIM-1 levels may predict mortality, whereas high cystatin C and preoperative NGAL levels may be indicative of AKI. These biomarkers deserve further investigation in larger study populations.

INCIDENCE, RISK FACTORS AND OUTCOMES OF ACUTE KIDNEY INJURY IN PRETERM NEWBORNS

Acute kidney injury is a sudden loss of renal function that results in deterioration of the  renal’s ability to excrete urine in sufficient quantity and adequate composition. The aim of the study was to determine the incidence, risk factors and outcomes of acute kidney injury in preterm newborns. The study was conducted at the University Clinic of Pediatrics–Skopje. It was a clinical, epidemiological prospective study. In the period of two years, 40 preterm newborns hospitalized at the Intensive Care Unit (ICU) with documented kidney injury were analyzed. Medical data records of hospitalized preterm infants with kidney injury were processed. The material was statistically analyzed using methods of descriptive statistics. We evaluated 40 preterm newborns with documented acute kidney injury, who at the period of 2 years were treated in the ICU. The prevalence of kidney injury was 6.9%. Most of the involved preterm newborns were male (72%), and born at 32 to 37 weeks with low birth weight (58%). Prerenal injury was evaluated in 79.5% of the cases. The mortality rate was 36% and it was significantly higher in the group of preterm infants born under 28 weeks, with Extremely Low Birth Weight Newborns ELBW. (P=0.01). Acute kidney injury is a life threatening condition with a still high mortality rate. Appropriate treatment of kidney injury in newborns with ELBW improves the outcomes and reduces the mortality of the disease. Key words: acute kidney injury, preterm newborns, ELBW

Острое почечное повреждение у новорожденных в неонатальных отделениях реанимации: результаты многоцентрового исследования

Острое почечное повреждение у новорожденных в неонатальных отделениях реанимации: результаты многоцентрового исследования

P1828A PANEL OF URINE BIOMARKERS FOR EARLY KIDNEY INJURY DETECTION IN NEWBORNS

Abstract Background and Aims Neonatal kidney damage is a wide spread pathology, especially among preterm infants. Acute kidney injury (AKI) in newborns remains one of the most important problems because the features of neonatal nephrogenesis and physiology. The current clinical criteria for the diagnosis of AKI, including pediatric scales pRIFLE and nRIFLE, rely on glomerulal filtration rate (GFR), blood urea nitrogen (BUN), and serum creatinine (SCr), which are the late biomarkers detectable only within days or weeks after kidney damage occurred, and therefore have limitations when used within the first days after birth. Therefore, sensitive and specific tests for early diagnostics of kidney injury are extremely needed in neonatology. Urine biomarkers appear to be promising for early diagnosis of AKI. Quite often renal pathologies result in markedly increased (or decreased) urinary excretion of a number of protein biomarkers, indicating subclinical tubular injury while conventional AKI signs are not manifested yet. The aim of this study was to determine clinical value of urine molecular biomarkers for the prediction of acute kidney injury in newborns. Method Urine samples from newborns with congenital malformation were collected on the 1st day after born, and then once a week until the 21th postnatal day. Urine samples were centrifuged, aliquoted and stored at –80°С until testing. The next urinary biomarkers were analyzed: calbindin 1, clusterin, IL-18, KIM-1, GST-π, MCP-1 and NGAL. Quantitative determination was performed with immunoassay kit Bio-Plex Pro™ RBM Human Kidney Toxicity Panel 1 (Bio-Rad Inc., USA) and Human NGAL ELISA kit (Invitrogen, Germany). Control group included five age-matched healthy infants. Results 8 of 20 patients showed a direct correlation of increased NGAL levels in urine (50-fold compared to control group) with high levels of C-reactive protein in the blood (3-10-fold rise above the reference level). NGAL is the most sensitive marker for assessing AKI or tubular damage. These 8 patients were further investigated for other urine biomarkers. The IL-18 level in urine was slightly increased in 4 patients. IL-18 is proposed to be a predictor for AKI severity and mortality in children with critical illness. KIM-1 has low basal expression in the normal kidney but its appearance is highly specific and sensitive sign for nephrotoxicity in proximal tubules. We observed the increase of KIM-1 urinary excretion for 7 patients. However, we discover the equal occurrence of decrease or increase of urine MCP-1 through studied patients. Elevated levels of urine MCP-1 were earlier observed in experimental maleate induced azotemia, LPS injection and in model of unilateral ureteral obstruction (UUO). An increase of KIM-1 and/or MCP-1 urinary excretion is known to be associated with some risk of AKI development. We found 3-fold growth of urine clusterin in 7 children. It is noticed, that clusterin increased in damaged tubular cells during polycystic kidney disease and renal carcinoma. Additionally, we revealed 7-fold decrease of calbindin 1 in urine of 7 patients. Сalbindin 1 exclusively localized in the kidney distal nephron segment, and its decrease was discribed for models of UUO, glomerulonephritis and cisplatin nephropathy. GST-π protein is found in cells lining the lumen of the distal tubules and is elevated in the urine of patients with sepsis, independently of accompanied AKI. We also observed 10- to 20-fold rising of urine GST-π for all 8 NGAL-positive newborns. Conclusion The specificity, rate of increase, and non-invasive detection of urine markers studied in this work, make them indispensable in clinical practice. However, their use in neonatology is still experimental. We showed potential applicability of wide biomarker panel for early detection and prediction of AKI in newborns.

NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN AS AN EARLY BIOMARKER OF ACUTE KIDNEY INJURY IN NEWBORNS.

SUMMARYThe aim of the study was to determine the incidence, risk factors and efficiency of the neutrophil gelatinase-associated lipocalin (NGAL) biomarker in early diagnosis of acute kidney injury (AKI) in newborns. The study was designed as a prospective, clinical, epidemiological investigation conducted in the period of three years, which included 50 newborns with AKI hospitalized in the Neonatal Intensive Care Unit, University Children’s Hospital in Skopje. The estimated prevalence of AKI was 6.4%, while the prevalence according to RIFLE classification was 8.7%. Perinatal asphyxia was a common predisposing factor associated to kidney injury. The mortality rate was 32% and was significantly higher in the group of newborns with congenital heart diseases. There was a significant difference between NGAL values and creatinine values on the day of admission. There was a significant difference in NGAL values between newborns with AKI and lethal outcome and newborns without lethal outcome (p<0.001). In conclusion, AKI is a life-threatening condition. It is an independent contributor to mortality. Urinary NGAL is an early predictive biomarker of AKI in critically ill newborns.

Frequency, Risk Factors, Clinical Course, and Effect on Mortality of Acute Kidney Injury in Newborns

Objective: Acute kidney injury (AKI) is still an important cause of morbidity and mortality in the neonatal period, despite recent improvements on perinatal care. In this study, the frequency, etiological causes, clinical characteristics, and mortality of newborns with AKI in a tertiary neonatal intensive unit (NICU) were investigated. Methods: Medical records of newborns admitted between 2007 and 2011 were evaluated and patients who developed AKI in the first 28 days of life were determined. Clinical characteristics, primary cause, mortality, and highest creatinine of newborns with AKI were recorded. Results: It was determined that 94 of 677 (13.9%) patients (80% of them in the first seven days of life) developed AKI. Hypovolemia, birth asphyxia, congenital heart disease, sepsis, and genitourinary system (GUS) anomalies were found to be the most frequent causes of AKI. The incidence of AKI and mortality rates were higher in patients with gestational age under 28 week and birth weight under 1000 g. Mortality tends to rise in the presence of AKI regardless of the underlying disease, but this was statistically significant only for sepsis and cardiac disease. The presence of AKI increases length of stay and, the creatinine level was found to be lower in those who survived. Conclusion: AKI is still an important morbidity in patients treated in NICU despite improvement on perinatal care. Low birth weight, prematurity, birth asphyxia, sepsis, hypovolemia, cardiac diseases, and GUS anomalies were common causes and mortality increases in patients with AKI regardless of gestational age, birth weight, and underlying etiology.

Acute Kidney Injury in Newborns

Neonatal acute kidney injury is a common clinical condition encountered in neonatal intensive care units. Acute kidney injury in newborns is associated with a poor prognosis and significantly increased risks of mortality and chronic kidney disease. Neonatal kidney function changes with gestation and neonatal extra-uterine adaptation affects the transformation and regulation of renal functions. In particular, premature infants are more likely to develop acute kidney injury due to incomplete kidney development, which increases the difficulty of care. It is necessary to understand the definition and risk factors of acute kidney injury in neonates as well as treatment options, which include maintai‑ning body fluid and water balance, stabilizing electrolyte levels, and implementing renal replacement therapy. Healthcare providers must carefully evaluate a newborn's physiological changes after birth and use relevant biological indicators to detect acute kidney injury as early as possible in order to prevent or reduce the risk of acute kidney injury and provide appropriate care to improve the quality of newborn care.

Acute kidney injury in newborns with necrotizing enterocolitis: risk factors and mortality

Both necrotizing enterocolitis and acute kidney injury are tightly related conditions, which independently increase mortality in newborns. Necrotizing enterocolitis is an inflammatory disease with a systemic repercussion that leads to inflammatory kidney changes predisposing to renal damage. This study assessed risk factors for the development of acute kidney injury in patients diagnosed with necrotizing enterocolitis and compared mortality between patients with or without acute kidney injury. Thirty-nine patients with the diagnosis of necrotizing enterocolitis were included, regardless of the gestational age. Of 39 patients, 38.5% developed acute kidney injury. Survival showed to be significantly lower in patients with acute kidney injury (54.4 days) when compared to newborns without acute kidney injury (76.22 days; p = 0.014). Mortality in patients with acute kidney injury was 46.7%, increasing up to 62.5% with severe kidney damage. The hazard ratio for mortality was 4.708 for acute kidney injury (p = 0.025). The severity of enterocolitis showed to be an independent risk factor in developing acute kidney injury and severe kidney injury (odds ratio [OR] = 1.841, p = 0.034 and OR = 1.917, p = 0.027, respectively). Newborns with necrotizing enterocolitis should be evaluated for early recognition of acute kidney injury. Prospective studies with a higher number of patients are needed to identify modifiable risk factors to impact in the prevention of these conditions.

Acute kidney injury in the newborn infant: classification, causes and epidemiology

In the article are presented classifications, causes and epidemiology of acute kidney injury (AKI) in newborns, unsolved problems. Neonatal AKI classifications proposed by Acute Kidney Injury Network (2007), JG Jetton, DJ Askenazi (2012), modifications from NKC, KDIGO, and AWAKEN (2016), AKI Workshop (2017) are discussed. The results of the international assessment Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN), JG Jetton et al (2016, 2017) are discussed. Of the 2022 babies, 605 (30 %) had the status of AKI: in 48 % of the 273 preterm neonates with gestatoinal age 22-29 weeks; 18 % of 916 preterm neonates with gestatoinal age 29-36 weeks; in 37 % of 833 neonates with gestatoinal age after 36 weeks. The risk factors for the development of early AKI in preterm infants include low gestational age and very low birth weight. According to international epidemiological studies, the development of AKI in premature newborns is the main and independent risk factor for mortality and the formation of chronic kidney disease. The absence of multicenter epidemiological studies of acute kidney damage in newborns in our country is still an unsolved problem. The solution of the problem facing the national neonatology should be aimed at ensuring a unified approach to the classifications of acute kidney damage, on studying epidemiology, features of development, course, and outcome of acute kidney damage of various etiologies, on developing algorithms for prevention, diagnosis and treatment in term and preterm infants.

Tubular and Glomerular Biomarkers of Acute Kidney Injury in Newborns.

Acute Kidney Injury (AKI) is a sudden decrease in kidney function. In the early period, the highest percentage of AKI occurs among newborns hospitalized in the neonatal intensive care units, especially premature neonates. The prognosis of AKI depends on the type and severity of the cause of an injury, the accuracy and the time of diagnosis and treatment. The concentration of serum creatinine is still the main diagnostic test, although it changes in the course of AKI later than glomerular filtration rate GFR. In addition, the reliability of the determination of creatinine level is limited because it depends on many factors. New studies have presented other, more useful laboratory markers of renal function that can be measured in serum and/or in urine. The aim of the work was to present the latest data about tubular and glomerular biomarkers of acute kidney injury in newborns. We undertook a structured search of bibliographic databases for peer-reviewed research literature by using focused review topics. According to the conceptual framework, the main idea of research literature has been summarized and presented in this study. The concentrations of some novel biomarkers are higher in serum and/or urine of term and preterm newborns with AKI, especially in the course of perinatal asphyxia. In this systematic review of the literature, we have highlighted the usefulness of biomarkers in predicting tubular and/or glomerular injury in newborns. However, novel biomarkers need to prove their clinical applicability, accuracy, and cost-effectiveness prior to their implementation in clinical practice.

Risk factors of acute cardiac surgery-associated kidney injury in newborns and infants with congenital heart defects

Objective. To identify risk factors for acute cardiac surgery-associated kidney damage in 214 newborns and infants with congenital heart defects. Results. 54.7% of 95 newborns and 46.2% of 119 infants have acute cardiac surgery-associated kidney injury. There have been determined statistically significant risk factors of acute cardiac surgery-associated kidney injury: in newborns – the level of lactate in blood plasma more than 2.5 mmol/l and artificial lung ventilation (87.1% as compared to 39.1% without these factors; 93.8 and 46.8% accordingly; р&lt;0.001), in infants – level of lactate in blood plasma more than 2.5 mmol/l before surgery as compared to those without these factors (96.4% as compared to 30.8% without this factor; р&lt;0.001).

Neutrophil gelatinase-associated lipocalin as predictor of acute kidney injury in neonates with perinatal asphyxia: a systematic review and meta-analysis.

Serum and urinary NGAL represent candidate biomarkers with high performance in the prediction of acute kidney injury in newborns with perinatal asphyxia. Before NGAL can be widely used in clinical practice, future large prospective studies are needed to define the optimal cutoffs and accurately determine which levels are suggestive of post-asphyxial acute kidney injury. What is Known: • Acute kidney injury is a major cause of morbidity and mortality in perinatal asphyxia. • Current markers are insufficient in predicting post-asphyxial acute kidney injury. What is New: • Area under the curve for serum and urinary neutrophil gelatinase-associated lipocalin is 0.818 and 0.899, respectively. • Neutrophil gelatinase-associated lipocalin is a useful marker for detecting asphyxiated neonates at risk of developing acute kidney injury.

Risk factors associated with acute kidney injury in newborns.

Acute kidney injury (AKI) in the newborn is a common problem in the neonatal intensive care unit with many underlying factors such as asphyxia, respiratory distress syndrome (RDS), and urogenital anomalies. The aim of this study is to highlight possible risk factors and profile of neonates developing AKI in the Neonatal Intensive Care Unit (NICU) of Cairo University Pediatric Hospital. The study was carried out on 90 neonates (30 patients and 60 controls), among neonates admitted to NICU. The study was done over two months, from January 2015 to March 2015. Our study showed that sepsis was detected in 53.3%, prematurity in 46.67%, RDS in 43.3%, congenital heart disease in 20%, and hypoxic-ischemic encephalopathy in 6.67% of patients. Maternal illness and low body temperature were both significant risk factors of AKI in neonates. History of maternal illness, low body temperature, sepsis, prematurity, and respiratory distress can contribute to the development of AKI in neonates.

3: A REVIEW OF NGAL BIOMARKER OR NEUTROPHIL GELATINASE ASSOCIATED LIPOCALIN

Background and aims:Neutrophil gelatinase-associated lipocalin or NGAL is biomarker protein by weight of 25 kDa that a bacteriostatic agent in the physiological state of the body against Gram-negative bacteria by...

Non-dialytic management of acute kidney injury in newborns.

Treating acute kidney injury (AKI) in newborns is often challenging due to the functional immaturity of the neonatal kidney. Because of this physiological limitation, renal replacement therapy (RRT) in this particular patient population is difficult to execute and may lead to unwanted complications. Although fluid overload and electrolyte abnormalities, as seen in neonatal AKI, are indications for RRT initiation, there is limited evidence that RRT initiated in the first year of life improves long-term outcome. The underlying cause of AKI in a newborn patient should determine the treatment strategies to restore appropriate renal function. However, our understanding of this common clinical condition remains limited, as no standardized, evidence-based definition of neonatal AKI currently exists. Non-dialytic management of AKI in these patients may restore appropriate renal function to these patients without exposure to complications often encountered with RRT.

Urinary markers of acute kidney injury in newborns with perinatal asphyxia

Background: Acute kidney injury (AKI) affects up to 60% of severely asphyxiated neonates. The diagnosis of AKI can be and is further challenged by a lack of good biomarkers. We studied the role of novel markers for AKI, neutrophil gelatinase-associated lipocalin (NGAL), interleukin-8 (IL-18), Netrin-1 (NTN-1), and sodium hydrogen exchanger isoform 3 (NHE3) on development and early diagnosis of AKI in newborns with perinatal asphyxia (PA). Methods: Forty-one newborns with a diagnosis of PA (15 with AKI and 26 without AKI) and 20 healthy matched controls were involved to the study. Urinary samples were obtained on postnatal days 1 and 4 for patients with PA and on postnatal day 1 for the control subjects. AKI was defined using a serum creatinine-based modification of the acute kidney injury network criteria. Results: The levels of NGAL, NTN-1, NHE3, and IL-18 on the first postnatal day urine samples were higher in patients compared to controls (p < 0.001, p <0.001, p <0.02, p <0.001, respectively). In patients with AKI, the levels of NGAL and IL-18 were higher when compared to patients without AKI (p = 0.002, p <0.001, respectively). The levels of NTN-1 and NHE3 were similar in both groups. For the samples obtained on postnatal day 4, only NGAL levels were significantly higher in patients with AKI (p = 0.004) compared to those without AKI. Conclusion: To our knowledge, this is the largest study, which evaluated the utility of urinary biomarkers in the diagnosis of AKI in newborns with PA. First day, urine NGAL and IL-18 levels have an important diagnostic power in such patients.