MO1012ACUTE KIDNEY INJURY IN PREMATURE INFANTS EXPOSED TO PERINATAL HYPOXIA

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Iuliia Kyslova ◽  
Tetiana Savrun ◽  
Olga Yablon ◽  
Oleksandr Mazulov ◽  
Natalia Nazarchuk
Keyword(s):  
Renal Artery ◽  
Cystatin C ◽  
Premature Infants ◽  
Flow Rate ◽  
Gestational Age ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Renal Tubules ◽  
Perinatal Hypoxia ◽  
Interleukin 18

Abstract Background and Aims Features of nephrogenesis and functional state of the kidneys of premature infants makes them extremely vulnerable to the damaging effects of hypoxia. The imperfection of traditional methods of diagnosis and non-specific clinical manifestations of ischemic nephropathy in premature infants requires the study of new informative diagnostic tests that would indicate the development of a pathological process in the renal tissue. The aim is to early diagnose acute kidney injury in preterm infants exposed to perinatal hypoxia, based on the study of renal blood flow and laboratory markers - cystatin C in serum, lipocalin and interleukin-18 in urine. Method We examined premature infants exposed to perinatal hypoxia and had signs of injury of kidney depending on gestational age: 65 infants with gestational age <32 weeks and 50 infants with gestational age > 32 weeks. The group of comparison included 25 premature newborns who were born without hypoxia and without signs of kidney injury. Blood and urine samples were obtained at 2-4 days of life. Ultrasound examination of the kidneys was performed at 3-5 days of life. Results The level of CysC in the serum of infants with gestational age <32 and> 32 weeks significantly exceeded this level in infants of the group of comparison (in infants with gestational age <32 weeks -2.50 [2.14; 3.26] ng/ml, in infants with gestational age> 32 weeks - 1.89 (1.49; 2.45] ng/ml), p <0.01. The value of NGAL in the urine of infants with gestational age <32 weeks - Me 96.03 [38,6; 131.23] ng/ml UCr and of infants with gestational age > 32 weeks - Me 75.10 [31,24; 126.6] ng/ml UCr against Me 25.9 [8.24; 44.64] ng/mg UCr in infants of the group of comparison (p <0.01). IL-18 in the urine of infants with gestational age <32 weeks and > 32 weeks was significantly higher than that in infants of the group of comparison (Me 27.98 [25.49; 29.51] pg/mg UCr, Me 22.0 [19.6; 25.63] pg/mg UCr, and 17.41 [13.96; 18.78] pg/mg UCr, respectively, p <0.01). According to the results of duplex scanning, the maximum systolic flow rate in the trunk of the renal artery (Vmax) in infants with gestational age <32 weeks (35.62 ± 3.2 cm/s) was lower than in infants of the group of comparison (p <0.05). Decreased IR less than 0.6 in 19 (29.3 ± 5.6%) infants with gestational age <32 weeks and in 12 (24.0 ± 6.4%) infants with gestational age > 32 weeks indicates vasodilation and, possibly arteriovenous shunting. The pulsation index in infants with gestational age <32 weeks and > 32 weeks (0.88 ± 0.1 and 0.98 ± 0.1) was significantly lower than in the group of comparison (p <0.05). Conclusion Early (2-4 days of life) and significant (p<0.01) increase in serum cystatin C, interleukin-18 and lipocalin associated with neutrophil gelatinase in the urine indicate endogenous renal dysfunction, damage to the proximal renal tubules in premature infants who were exposed to perinatal hypoxia. Significant decrease in the maximum systolic flow rate in the trunk of the renal artery and pulsation index (p<0.05) in premature infants who underwent perinatal hypoxia indicate a significant impact of circulatory disorders on the formation of hypoxic nephropathy.

scholarly journals Acute Kidney Injury and Bronchopulmonary Dysplasia in Premature Neonates Born Less than 32 Weeks' Gestation

2019 ◽  
Vol 37 (03) ◽  
pp. 341-348 ◽  
Author(s):  
Michelle C. Starr ◽  
Louis Boohaker ◽  
Laurie C. Eldredge ◽  
Shina Menon ◽  
Russell Griffin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Gestational Age ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Multiple Factors

Abstract Objective This study aimed to evaluate the association between acute kidney injury (AKI) and bronchopulmonary dysplasia (BPD) in infants born <32 weeks of gestational age (GA). Study Design Present study is a secondary analysis of premature infants born at <32 weeks of GA in the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) retrospective cohort (n = 546). We stratified by gestational age and used logistic regression to determine association between AKI and moderate or severe BPD/mortality. Results Moderate or severe BPD occurred in 214 of 546 (39%) infants, while death occurred in 32 of 546 (6%); the composite of moderate or severe BPD/death occurred in 246 of 546 (45%). For infants born ≤29 weeks of gestation, the adjusted odds ratio (OR) of AKI and the primary outcome was 1.15 (95% confidence interval [CI] = 0.47–2.86; p = 0.76). Infants born between 29 and 32 weeks of gestation with AKI had four-fold higher odds of moderate or severe BPD/death that remained after controlling for multiple factors (adjusted OR = 4.21, 95% CI: 2.07–8.61; p < 0.001). Conclusion Neonates born between 29 and 32 weeks who develop AKI had a higher likelihood of moderate or severe BPD/death than those without AKI. Further studies are needed to validate our findings and evaluate mechanisms of multiorgan injury.

scholarly journals Prediction of early diagnosis of acute kidney injury in premature infants with hemodynamically significant patent ductus arteriosus

2020 ◽  
pp. 5-11
Author(s):  
T.P. Borysova ◽  
◽  
O.U. Obolonska ◽  
O.E. Khudyakov ◽  
◽  
...  
Keyword(s):  
Blood Flow ◽  
Patent Ductus Arteriosus ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Flow Velocity ◽  
Premature Infants ◽  
Blood Flow Velocity ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
Patent Ductus

The development of acute kidney injury (AKI) in preterm infants with hemodynamically significant patent ductus arteriosus (HSPDA) is an additional burden on homeostatic mechanisms, leading to loss of fluid, electrolyte balance, and acid-base disturbance and increasing the risk of mortality by 50%. Therefore, early detection of AKI in preterm infants with HSPDA is extremely important in terms of improving treatment outcomes. Purpose — to create, evaluate and further analyze the binary logistic regression model of AKI on the background of HSPDA in premature infants. Materials and methods. The group of study participants consisted of 40 premature babies with HSPDA, who were admitted for treatment on the first day of life to the Department of Anesthesiology and Neonatal Intensive Care at MI «Dnepropetrovsk Regional Children's Clinical Hospital» Dnepropetrovsk Regional Council». On the third to fifth day of life, 23 (57.5%) patients were diagnosed with AKI. Clinical and laboratory examination included obstetric history, gestational age, weight, physical examination, clinical analysis of blood and urine, arterial blood oxygen saturation, biochemical methods — examination of urea, serum and urine creatinine, serum and urine sodium, serum potassium. The concentration index of creatinine, fractional excretion of sodium, glomerular filtration rate (GFR) according to the Schwartz formula were calculated. Instrumental methods of examination included echocardiography with Doppler, ultrasound Doppler of renal vessels, renal spectroscopy in the near infrared region. In order to preliminarily determine the diagnostic potential of some clinical'anamnestic and laboratory data, the parameters of the sample with AKI and the sample without this pathology were compared: in the case of interval scale the Mann–Whitney U-test was used, in the case of categorical scale — χ2-test or Fisher's exact test. Spearman's rank correlation was used to form the optimal set of input variables for regression modeling. The method of binary logistic regression was used to develop a diagnostic model of AKI development on the background of HSPDA in premature infants. Results. At the stage of exploratory data analysis (several dozen parameters of clinical and biochemical analysis of blood and urine, renal hemodynamics, renal oxygenation and therapeutic measures on the first day), as well as clinical and anamnestic data, it was found that AKI has a significant relationship with 14 interval ( maximum blood flow velocity in the interlobar renal artery, minimum blood flow velocity in the interlobar renal artery, resistance index in the interlobar renal artery, maximum blood flow velocity in the main renal artery, diameter of the open arterial duct, renal oxygenation, fractional renal tissue extraction of oxygen, serum creatinine, GFR, creatinine concentration index, urinary sodium, fractional sodium excretion, urine protein, diastolic blood pressure) and 9 nominal values (the size of the patent ductus arteriosus on the first day of more than 2 mm, ibuprofen therapy at a dose of 20 mg/kg on the first day, ibuprofen therapy on the first day of life, furosemide treatment, history of renal disease in the mother, chronic foci of infection in the mother, hypertension of pregnancy, threat of abortion, necrotizing enterocolitis in the patient on the first day of life). Conclusions. The most significant predictors of AKI development in premature infants with HSPDA are the parameter of maximum blood flow velocity in the interlobar renal artery, HSPDA diameter greater than 2 mm and serum creatinine level on the first day of life. The sensitivity of the AKI logistic regression model, in which HSPDA diameter and serum creatinine level are used as explanatory variables, is 91%, specificity — 88%, overall accuracy — 90%. Replacement of serum creatinine in the logit function for the maximum blood flow velocity in the interlobar renal artery allows to increase the sensitivity of the model up to 96%, and the overall accuracy up to 93%. The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of parents of children was obtained for the research. The authors were declare no conflict of interest. Key words: hemodynamically significant patent ductus arteriosus, premature infants, acute kidney injury, prediction of early diagnosis.

Effect of infusion duration on high-dose methotrexate (HDMTX) acute kidney injury (AKI).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e22013-e22013
Author(s):  
Elizabeth Fox ◽  
Christine Busch ◽  
Alexander DeBernardo ◽  
Kristin Levin ◽  
Yan Zhu ◽  
...  
Keyword(s):  
Cystatin C ◽  
Kidney Injury ◽  
Solubility Limit ◽  
High Dose ◽  
Tubular Damage ◽  
Renal Tubules ◽  
Urine Ph ◽  
Fluorescence Polarization Assay ◽  
Renal Tubular ◽  
Clinical Trial Information

e22013 Background: HDMTX AKI delays MTX excretion and increases the risk for severe systemic toxicity. MTX is thought to crystalize in renal tubules at urine [MTX] above the solubility limit, leading to AKI. Methods: Pharmacokinetic simulations of plasma and urine [MTX] at varying infusion durations (IDs) for 12 g/m2 MTX dose identified 12 h as the shortest duration with urine [MTX] below the solubility limit at pH 7.5. Using a randomized crossover design, we compared 4h and 12h IDs in patients with osteosarcoma treated with 12 g/m2 MTX. Urine AKI biomarkers (NAG, NGAL, KIM-1), urinalysis, and estimated glomerular filtration rate (GFR) were endpoints. [MTX] was measured in plasma using a commercial fluorescence polarization assay and in urine by HPLC. Results: Twelve patients, age 12.8 (5.6-19) y, received 12 g/m2 HDMTX over 4 h (40 infusions) and 12 h (35 infusions). At baseline (BL), GFR was 120 (100-175) mL/min/1.73m2; Median (range) NAG [21(5-64) U/gCr] and NGAL [11(0.7-325) µg/gCr] were normal and KIM-1 [0.9(0.4-6.3) µg/gCr] was elevated. Urine pH was maintained > 7 for all infusions. Proteinuria occurred during 93% of infusions. Table 1 compares 4h and 12h IDs. One patient had HDMTX AKI during a 12 h ID (data excluded from Table); end of infusion (EOI) [MTX] was 930 µM in plasma and 38 mM in urine. By 24h after the start of the HDMTX infusion, serum creatinine (sCr) was 1.4 mg/dL (3.5x BL), cystatin C was 1.0 (1.4x BL); NAG, NGAL and Kim-1 increased by > 350%. At 40h, plasma [MTX] was 40 µM; glucarpidase was administered. Plasma [MTX] < 0.1 µM was achieved at 310 h. Recovery to BL occurred at 20 d for sCr and 40 d for cystatin C. Conclusions: Transient proteinuria, increase in KIM-1 and NAG indicate acute proximal renal tubular damage in all HDMTX infusions regardless of ID. EOI urine [MTX] after 4 h or 12 h IDs did not exceed the solubility limit, including the patient with clinical HDMTX AKI. These results suggest that MTX crystallization in urine may not be the primary mechanism of HDMTX AKI. Clinical trial information: NCT01848457. [Table: see text]

scholarly journals Changes in Novel AKI Biomarkers after Exercise. A Systematic Review

2020 ◽  
Vol 21 (16) ◽  
pp. 5673 ◽  
Author(s):  
Wojciech Wołyniec ◽  
Wojciech Ratkowski ◽  
Joanna Renke ◽  
Marcin Renke
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Physical Exercise ◽  
Cystatin C ◽  
Binding Protein ◽  
Kidney Injury ◽  
Study Groups ◽  
Metabolic Adaptation ◽  
Interleukin 18 ◽  
Fatty Acid Binding

More than 100 substances have been identified as biomarkers of acute kidney injury. These markers can help to diagnose acute kidney injury (AKI) in its early phase, when the creatinine level is not increased. The two markers most frequently studied in plasma and serum are cystatin C and neutrophil gelatinase-associated lipocalin (NGAL). The former is a marker of kidney function and the latter is a marker of kidney damage. Some other promising serum markers, such as osteopontin and netrin-1, have also been proposed and studied. The list of promising urinary markers is much longer and includes cystatin C, NGAL, kidney injury molecule-1 (KIM-1), liver-type fatty-acid-binding protein (L-FABP), interleukin 18, insulin-like growth factor binding protein 7 (IGFBP-7), tissue inhibitor of metalloproteinases-2 (TIMP-2) and many others. Although these markers are increased in urine for no longer than a few hours after nephrotoxic agent action, they are not widely used in clinical practice. Only combined IGFBP-7/TIMP-2 measurement was approved in some countries as a marker of AKI. Several studies have shown that the levels of urinary AKI biomarkers are increased after physical exercise. This systematic review focuses on studies concerning changes in new AKI biomarkers in healthy adults after single exercise. Twenty-seven papers were identified and analyzed in this review. The interpretation of results from different studies was difficult because of the variety of study groups, designs and methodology. The most convincing data concern cystatin C. There is evidence that cystatin C is a better indicator of glomerular filtration rate (GFR) in athletes after exercise than creatinine and also at rest in athletes with a lean mass lower or higher than average. Serum and plasma NGAL are increased after prolonged exercise, but the level also depends on inflammation and hypoxia; therefore, it seems that in physical exercise, it is too sensitive for AKI diagnosis. It may, however, help to diagnose subclinical kidney injury, e.g., in rhabdomyolysis. Urinary biomarkers are increased after many types of exercise. Increases in NGAL, KIM-1, cystatin-C, L-FABP and interleukin 18 are common, but the levels of most urinary AKI biomarkers decrease rapidly after exercise. The importance of this short-term increase in AKI biomarkers after exercise is doubtful. It is not clear if it is a sign of mild kidney injury or physiological metabolic adaptation to exercise.

scholarly journals Postnatally acquired cytomegalovirus infection in extremely premature infants: how best to manage?

2019 ◽  
Vol 105 (3) ◽  
pp. 334-339 ◽  
Author(s):  
Seilesh Kadambari ◽  
Elizabeth Whittaker ◽  
Hermione Lyall
Keyword(s):  
Birth Weight ◽  
Natural History ◽  
Premature Infants ◽  
Gestational Age ◽  
Cytomegalovirus Infection ◽  
Very Low Birth Weight ◽  
Clinical Manifestations ◽  
Term Infants ◽  
Symptomatic Disease ◽  
History Of

Postnatal cytomegalovirus (pCMV) infection is a common viral infection typically occurring within the first months of life. pCMV refers to postnatal acquisition of CMV rather than postnatal manifestations of antenatal or perinatal acquired CMV. pCMV is usually asymptomatic in term infants, but can cause symptomatic disease in preterm (gestational age <32 weeks) and very low birth weight (<1500 g) infants resulting in sepsis, pneumonia, thrombocytopaenia, neutropaenia, hepatitis, colitis and occasionally death. There are significant uncertainties regarding the management of premature infants with pCMV disease which is in part due to our limited understanding of the natural history of this disease. This review describes the current epidemiology and clinical manifestations of pCMV disease which should alert clinicians to test for CMV and also outlines a strategy to manage the condition.

scholarly journals Urine interleukin-18 and cystatin-C as biomarkers of acute kidney injury in critically ill neonates

2012 ◽  
Vol 27 (5) ◽  
pp. 851-860 ◽  
Author(s):  
Yanhong Li ◽  
Chenlu Fu ◽  
Xiaofei Zhou ◽  
Zhihui Xiao ◽  
Xueming Zhu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Cystatin C ◽  
Kidney Injury ◽  
Interleukin 18 ◽  
Critically Ill Neonates

scholarly journals Features of renal blood flow in acute kidney injury in premature infants with hemodynamically significant patent ductus arteriosus

2021 ◽  
pp. 14-18
Author(s):  
T.P. Borysova ◽  
◽  
O.Yu. Obolonska ◽  
Т.К. Мavropulo ◽  
L.P. Badogina ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Blood Flow ◽  
Patent Ductus Arteriosus ◽  
Renal Artery ◽  
Renal Blood Flow ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
The Third ◽  
Patent Ductus

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.

Relevance of cystatin-C, N-acetylglucosaminidase, and Interleukin-18 with the diagnosis of acute kidney injury induced by cadmium in rats

2017 ◽  
Vol 31 (11) ◽  
pp. e21968 ◽  
Author(s):  
Ola Sayed Mohamed Ali ◽  
Shereen Saeid Elshaer ◽  
Hend Mohamed Anwar ◽  
Mamdouh Salah EL-din Zohni
Keyword(s):  
Acute Kidney Injury ◽  
Cystatin C ◽  
Kidney Injury ◽  
Interleukin 18
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