Comparative study of clinico-biochemical profile and outcome of acute kidney injury in outborn and inborn neonates

Authors

  • Nayan Kumar Department of Pediatrics, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India
  • B. S. Karnawat Department of Pediatrics, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India
  • Navneet Badaya Department of Pediatrics, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20182552

Keywords:

Acute Kidney Injury (AKI), Outborn neonates, Inborn neonates

Abstract

Background: Acute Kidney Injury (AKI) is one of the major clinical problem in hospitalised neonates having variable outcomes. Prognosis depends on early diagnosis, associated risk factors and type of renal failure. The present study was undertaken to evaluate and compare risk factors, biochemical derangements and outcome of AKI in outborn and inborn neonates.

Methods: For this hospital based prospective study 100 neonates were enrolled who were admitted in the NICU, diagnosed as AKI who had serum creatinine >1.5mg/dl. Study was done for 1 year from June 2016 onwards.

Results: A large majority (72.3%) cases were outborn neonates (extramural) whereas (27.7%) cases were inborn neonates (intramural). Most of (79.8%) cases were term and were admitted during summer months. In outborn, type of AKI in descending order was prerenal (64.7%), renal (33.8%) and postrenal (1.5%) while in inborn neonates, cases were equally (50%) divided in between renal and prerenal. Among outborn neonates risk factors for AKI was dehydration (44%), sepsis (28%) and shock (16%) whereas in inborn, perinatal asphyxia (31%), dehydration (27%), shock (23%) and sepsis (11.5%) were risk factors. In outborn 36.8% cases were oliguric whereas in inborn 53.9% cases were oliguric.

Conclusions: The maximum cases of AKI were outborn neonates in which outborn dehydration was the commonest cause while in inborn neonates perinatal asphyxia was the commonest cause. Sepsis and shock were other causes in both groups. Presence of oliguria, intrinsic AKI and shock carried poor prognosis.

References

Mortazavi F, Sakha SH, Nejati N. Acute kidney failure in neonatal period. Iran J Kidney Dis. 2009;3:136-40.

Hentschel R, Lodige B, Bulla M. Renal insufficiency in the neonatal period. Clin Nephrol. 1996 Jul;46(1):54-8.

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG et al. Acute Kidney Injury Network (AKIN): report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute dialysis quality initiative workgroup. acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204-R212.

WHO newborn CC - acute renal failure in neonates. Available at https://www.newbornwhocc.org/2014_pdf/Acute%20renal%20failure%202014.pdf. Accessed on 23.09.2016.

Gouyon JB, Guignard JP. Management of acute renal failure in newborns. Pediatr Nephrol. 2000 sept;14(10-11):1037-44.

Ariede A, Bello M, Weerasinghe HD. Acute renal failure in the newborn: incidence and outcome. J Paediatr Child Health. 1997;33(3):246-9.

Yaseen H, Salem M, Darwich M. Clinical presentation of hypernatremic dehydration in exclusively breastfed neonates. Indian J Pediatr. 2004 Dec;71(12):1059-62.

Sumitra N, Alka P, Naranjan HS, Naveen B, Umest L, Govind Raj M. Study of acute renal failure in the newborn. Abstract, Pedicon, Chennai, 2002:189.

Gharehbaghi MM, Peirovifar A. Evaluating causes of acute renal failure in newborn infants. Pak J Med Sci. 2007 (part II);23(6):877-880.

Gupta SK, Karnawat B.S. Clinical study of acute renal failure in critically sick neonates. RUHS, Rajasthan;2010.

Devina, Karnawat BS. Study to find out epidemiological factors and biochemical derangements in dehydration fever and it’s management, RUHS, Rajasthan;2016.

Kapoor K, Jajoo M, Dabas V. Predictors of mortality in out born neonates with acute renal failure; an experience of a single center. Iran J pediatr. 2013 Jun;23(3):321-6.

Jayashree G, Dutta AK, Sarna MS, Saili A. Acute renal failure in asphyxiated newborns. Indian Pediatr. 1991 Jan;28(1):19-23.

Mathew OP, Jones AS, James E, Bland H, Groshong T. Neonatal renal failure: usefulness of diagnostic indices. Pediatrics.1980 Jan;65(1):57-60.

Norman ME, Asadi FK. A prospective study of acute renal failure in the newborn infants. Pediatr. 1979;63:475-9.

Jayashree G, Saili A, Sarna MS, Dutta AK. Renal dysfunction in septicemic newborns. Indian Pediatr. 1991 Jan;28(1):25-9.

Bansal SC, Nimbalkar AS, Kungwani AR, Patel DV, Sethi AR, Nimbalkar SM. Clinical profile and outcome of newborns with acute kidney Injury in a level 3 neonatal Unit in Western India. JCDR. 2017 Mar; 11(3):SC01-SC04.

Afroz S, Ferdous T, Hanif M, Mollah MAH, Banerjee M, Khan TH. Etiology and outcome of neonatal acute kidney injury in a special care baby unit. Northern Int Med Coll J. 2016 Jan;7(2):127-130.

Downloads

Published

2018-06-22

Issue

Section

Original Research Articles