scholarly journals Acute Kidney Injury (AKI) in perinatal asphyxia

2014 ◽  
Vol 2 (02) ◽  
pp. 60-65 ◽  
Author(s):  
Girish Gopal
Keyword(s):  
Acute Kidney Injury ◽  
Creatinine Clearance ◽  
Biochemical Parameters ◽  
Perinatal Asphyxia ◽  
Fluid Challenge ◽  
Kidney Injury ◽  
Renal Functions ◽  
Significant Difference ◽  
Urine Microscopy ◽  
Ischemic Encephalopathy

Background: Acute kidney injury (AKI) is a common consequence of perinatal asphyxia, occurring in upto 56% of these neonates. It is important to recognize AKI in asphyxiated neonates to facilitate administration of appropriate fluids and electrolytes in order to improve their outcome. Objectives: To determine the incidence of AKI in asphyxiated neonates and to correlate the severity and type of AKI with Apgar score and severity of hypoxic ischemic encephalopathy (HIE). Methods: 75 neonates were enrolled – 50 asphyxiated and 25 healthy neonates. Renal functions were assessed using urine output, urine microscopy, biochemical parameters and sonography. The values obtained were correlated with the severity of HIE. Neonates with AKI were managed as per unit protocol. Results: Of the 50 asphyxiated neonates, 32 (64%) had AKI: 25 (78.12 %) neonates with pre-renal AKI and the remaining 7 (21.88 %) with intrinsic AKI. Out of the 32 asphyxiated neonates with AKI, 12 (37.5%) had oliguric AKI, while the remaining 20 (62.5%) had non-oliguric AKI. Levels of blood urea and serum creatinine were significantly higher in asphyxiated neonates as compared to healthy controls (p 0.001). Biochemical derangements correlated well with the severity of HIE and Apgar scores. Serum sodium and creatinine clearance showed significantly different values in asphyxiated babies compared to controls. There was no significant difference in the urine ouput in the control and study group. Sonographic abnormalities were seen most often in oliguric babies, and indicated bad prognosis. Mortality was higher in babies with oliguric AKI. Conclusions: Perinatal asphyxia is an important cause of neonatal AKI. Majority of the babies had non-oliguric AKI and responded well to fluid challenge. Abnormalities in the renal function correlates well with the severity of HIE. Intrinsic AKI, oliguria, hyponatremia, reduced creatinine clearance and abnormal sonographic scan suggest bad prognosis in neonatal AKI secondary to perinatal asphyxia.

Acute Kidney Injury in Perinatal Asphyxia: Comparison Between Term and Preterm Neonates

2018 ◽  
Vol 32 (2-3) ◽  
pp. 50-59
Author(s):  
Preeti Malhotra ◽  
Simran Kaur Syal ◽  
Ankush Singh ◽  
Karuna Thapar
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Renal Injury ◽  
Perinatal Asphyxia ◽  
Kidney Injury ◽  
Preterm Neonates ◽  
Acute Renal Injury ◽  
Sodium Potassium ◽  
Significant Difference ◽  
Ischemic Encephalopathy

Objective: To investigate asphyxiated neonates for acute kidney injury, compare the occurrence between preterms and terms and to correlate the severity and type of renal injury with the degree of asphyxia and hypoxic ischemic encephalopathy (HIE) grading. Materials and Methods: Renal functions were assessed using urine output and biochemical parameters such as blood urea, serum creatinine, serum sodium, potassium, and calcium. These were evaluated on alternate days till day 7 or recovery or death. Results: Total 108 asphyxiated neonates were enrolled: 63 term and 45 preterm. A total of 28 (25.9%) developed acute kidney injury: 9 (32.1%) had oliguric acute renal injury and the rest 19 (67.8%) had nonoliguric acute renal injury. A total of 77.7% neonates had a prerenal cause and the other 22.2% had an intrinsic cause for the kidney injury. Levels of blood urea and serum creatinine were maximally elevated on day 5 of life. Biochemical derangements correlated well with the Apgar score at birth and severity of HIE. No statistically significant difference was observed in the incidence of renal injury between preterm and term asphyxiated neonates. Conclusion: Perinatal asphyxia is an important cause of renal injury in neonates. A majority of neonates had nonoliguric and pre renal type of acute kidney injury. The more severe the degree of asphyxia, the more prone they were to develop renal complications.

scholarly journals Clinical profile of acute kidney injury in neonates with perinatal asphyxia

2021 ◽  
Author(s):  
Revanasiddappa Bhosgi ◽  
Kirankumar Harwalkar
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Serum Creatinine ◽  
Early Recognition ◽  
Perinatal Asphyxia ◽  
Kidney Injury ◽  
Term Neonates ◽  
Renal Functions ◽  
Appropriate Treatment ◽  
Stage 1

Background: Acute kidney injury (AKI) is one of the most common complication observed in perinatal asphyxia. Early recognition is required for appropriate treatment and improve the outcome.Methods: It is a hospital based retrospective study conducted from august 2019 to December 2019. Total 85 full term neonates with perinatal asphyxia were included in the study. Renal functions were assessed by monitoring urine output, serum creatinine and ultrasonography. Acute kidney injury assessed by pRIFLE criteria and HIE staging is done by modified Sarnat and Sarnat staging. Severity of AKI is correlated with stages of HIE. AKI is managed as per unit protocol.Results: Total 85 perinatal asphyxia neonates were included in the study. Out of total 85 neonates, 25 (29.4%) neonates had evidence of acute kidney injury. Among 25 neonates with acute kidney injury, higher percentage was observed in male neonates which was 14 (56%) against 11 (44%) among female neonates. Predominantly, non oligouric acute kidney injury was observed among acute kidney injury neonates which accounted to 20 neonates (80%) (p-0.258). Serum creatinine between 1.5-2 mg/dl was observed in 18 (21.1%) neonates and 7 (8.2%) neonates had creatinine between 2-3 mg/dl. Sonological abnormality was noted in 2 (2.3%) neonates. Among neonates with non oligouric AKI, 3 (12%) neonates had HIE stage 1, 15 (60%) had HIE-2 and 7 (28%) had HIE-3. However, neonates with non oligouric AKI were higher among HIE 2 when compared to neonates with oligouric renal failure who were higher in HIE 3. No mortality occurred among these neonates.Conclusions: Majority of the neonates with perinatal asphyxia had non oliguric AKI which responded well to conservative treatment. AKI is most commonly seen in HIE stage 2 babies. Since non oligouric renal failure was a predominant finding among asphyxiated neonates, Serum creatinine monitoring remains main stay of diagnosis. 

The incidence of acute kidney injury among children treated for fever and neutropenia after elimination of empiric gentamycin use.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 120-120
Author(s):  
Andras Heczey ◽  
Kathy McCarthy ◽  
Meng-Fen Wu ◽  
Curtis Kennedy ◽  
Marilyn Hockenberry
Keyword(s):  
Acute Kidney Injury ◽  
Creatinine Clearance ◽  
Treatment Success ◽  
Intervention Group ◽  
Kidney Injury ◽  
Post Intervention ◽  
Randomized Controlled Clinical Trials ◽  
Significant Difference ◽  
Baseline Creatinine ◽  
Post Intervention Group

120 Background: The mortality rate of chemotherapy-related fever and neutropenia (F&N) has decreased significantly in recent years with attention shifting to antibiotic regimens with the least side effects. Multiple randomized controlled clinical trials have demonstrated that antibiotic regimens without aminoglycosides are sufficient for successful treatment of F&N and the addition of aminoglycosides significantly increases the risk of acute kidney injury among adults. The institutional F&N Guideline of Texas Children’s Hospital (TCH) mandated the use of gentamycin in combination vancomycin and piperacillin-tazobactam (P-T) for the treatment of hig- risk (HR) patients with F&N. To decrease the incidence of nephrotoxicity while maintaining excellent survival, empiric gentamycin use was stopped. Methods: Bacterial susceptibility and characteristics of patients with positive blood cultures treated at TCH during 2009 were retrospectively analyzed (pre-intervention group). Negligible P-T resistance was confirmed among bacterial isolates and empiric use of gentamycin for HR patients with F&N was stopped. After a 6 month adjustment period, data for all patients treated according to the new HR algorithm were prospectively collected (post-intervention group) for 12 months. The pre- and post-intervention groups were evaluated for differences in treatment success and incidence of nephrotoxicity. Results: Data from 69 patients from the pre-intervention group and 39 patients from the post-intervention group who had bacteremia were analyzed. No statistical difference was found between pre- and post-intervention groups for age, gender, survival, baseline creatinine level and baseline estimated creatinine clearance. However, significant difference was found for change in creatinine levels (0.12 vs. 0.04 mg/dl p=0.01), change in estimated creatinine clearance (24.8 vs. 12.1ml/min/1.73m2, p=0.01) and incidence of acute kidney injury (30.1 vs. 11.1%, p=0.04). Conclusions: Children with high risk F&N episode may be treated effectively and safely with decreased incidence of acute kidney injury without the empiric use of gentamycin.

scholarly journals Etiology and outcome of Neonatal Acute Kidney Injury in a Special Care Baby Unit

2016 ◽  
Vol 7 (2) ◽  
pp. 127-130
Author(s):  
Shireen Afroz ◽  
Tahmina Ferdous ◽  
Mohammed Hanif ◽  
Md Abid Hossain Mollah ◽  
Manisha Banarjee ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Perinatal Asphyxia ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Special Care ◽  
Failure Group ◽  
Medical College ◽  
Renal Functions ◽  
Special Care Baby Unit

Background : The cause of acute kidney injury (AKI) in neonate is multifactorial. The short-term outcome of AKI in newborns is highly dependent on the underlying etiology, the condition of other organs, and the facilities for renal replacement therapy.Objective : The aims of the present study were to find out the etiology and immediate outcome of AKI in neonate.Methodology : This observational study was done over a period of six months, at special care baby unit (SCABU) in Dhaka Medical College Hospital (DMCH). Neonates (aged 3-28 days) admitted in SCABU, who had AKI were the study population. Among them 44 neonates with AKI were included purposivly. AKI was diagnosed and classified by pediatric RIFLE (pRIFLE) staging criteria. Etiology of AKI was find out by dividing pre renal, renal and post renal cause of AKI. All neonates were treated conservatively and with intermittent peritoneal dialysis (IPD) as needed. Immediate hospital outcome was determined by improved with normal renal functions; improved with impaired renal functions and death.Result : The diagnosis based on estimated creatinine clearance (eCCL) criteria of pRIFLE showed that 43.2% neonates were at risk (R) stage, 22.7% were at injury (I) stage and 34.1% of neonates were at Failure (F) stage of AKI. Among 44 neonates 21 were male and 23 were female. Pre renal cause of AKI is predominant in this series. More than two-thirds (68.2%) of the neonates experienced perinatal asphyxia stage-II and III and 52.3% were exposed to meconium stained liquor during delivery. Septicemia with shock, history of aminoglycoside use were reported to be 59.1%, 52.3% respectively. Post renal cause was found in 16% neonates, like obstructive uropathy due to posterior urethral valve, exstrophy bladder and cloacal exstrophy. Neonate at Failure stage of AKI (n=15) had a significantly longer stay at SCABU (p < 0.001). Multiorgan failure was found to be significantly higher in failure group (p = 0.026). Majority of the failure group needed dialysis (p < 0.001). Most of the neonate at risk and injury stage was improved with normal renal functions. The resolution from AKI was almost similar among the groups (p = 0.885). The mortality was progressively higher from Risk to Failure Groups (p = 0.106). Overall 27% of the neonates diagnosed as AKI died from this illness, 57% improved with normal renal function and 16% improved with impaired renal function.Conclusion : The study concluded that perinatal asphyxia, septicemia with shock and use of aminoglycosides were the commonest cause of AKI in neonate. The mortality was higher in Failure group.Northern International Medical College Journal Vol.7(2) Jan 2016: 127-130

scholarly journals Study of incidence of acute kidney injury in asphyxiated neonates with hypoxic ischemic encephalopathy

2020 ◽  
Vol 7 (11) ◽  
pp. 2205
Author(s):  
Rita Chaudhary ◽  
Anil Kumar Tiwari ◽  
Farhan Usmani
Keyword(s):  
Acute Kidney Injury ◽  
Early Recognition ◽  
Perinatal Asphyxia ◽  
Kidney Injury ◽  
Hypoxic Ischemic Encephalopathy ◽  
Control Group ◽  
Medical College ◽  
Minute Apgar Score ◽  
Ischemic Encephalopathy ◽  
Control Study

Background: Perinatal asphyxia causes multi organ dysfunction resulting in renal (50%) and neurological (28%) compromise with 1.4% of hypoxic ischemic encephalopathy (HIE) and almost 20% death in India. Early recognition of acute kidney injury (AKI) is important in babies with HIE to facilitate appropriate fluid and electrolyte management for a stable biochemical milieu is vital.Methods: A prospective case control study was done in Patna Medical College and Hospital, Patna between January 2019 and March 2020. 70 term asphyxiated neonates with HIE as cases and 70 healthy neonates as control were taken. AKI on basis of p RIFLE criteria and HIE on the basis of 5 minute APGAR score were determined and correlated.Results: 58.6%cases of AKI with 73% pre renal and 61% non-oliguric type were found in asphyxiated neonates with HIE blood urea and serum creatinine values were significantly higher in asphyxiated babies than control group babies (p<0.0001).Conclusions: The extent of AKI is directly proportional to severity of HIE. 

scholarly journals P7: ACUTE KIDNEY INJURY AFTER ELECTIVE COLORECTAL SURGERY: RESULTS OF A NATIONAL CLOSED-LOOP AUDIT

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
Keyword(s):  
Acute Kidney Injury ◽  
Quality Improvement ◽  
Colorectal Surgery ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Elective Colorectal Surgery ◽  
National Quality ◽  
Significant Difference ◽  
The Uk

Abstract Introduction The aim of this study was to re-audit the rates of acute kidney injury (AKI) after elective colorectal surgery, following local presentations of results. Method Outcomes After Kidney injury in Surgery (OAKS) and Ileus Management International (IMAGINE), were prospective multicentre audits on consecutive elective colorectal resections, in the UK and Ireland. These were performed over 3-month periods in 2015 and 2018 respectively. During the interim period, results were presented at participating centres to stimulate local quality improvement initiatives. Risk-adjusted 7-day postoperative AKI rates were calculated through multilevel logistic regression based on the OAKS prognostic score. Result Of the 4,917 patients included, 3,133 (63.7%) originated from OAKS and 1,784 (36.3%) from IMAGINE. On univariate analysis, there was no significant difference (p=0.737) in the 7-day AKI rate between OAKS (n=346, 11.8%) and IMAGINE (n=205, 11.5%). However, the risk-adjusted AKI rate in IMAGINE was significantly lower compared to OAKS (-1.8%, 95% CI: -2.3% to -1.3%, p&lt;0.001). Of 47 centres (40.1%) with a recorded local presentation, there was no significant difference in the subsequent AKI rate in IMAGINE (-0.7%, -2.0% to 0.6%, p=0.278). Conclusion Rates of AKI after elective colorectal surgery significantly reduced on re-audit. However, this may be related to increased awareness from participation or national quality improvement initiatives, rather than local presentation of results. Abbrev. AKI - Acute Kidney Injury, OAKS - Outcomes After Kidney injury in Surgery, IMAGINE - Ileus Management International Take-home message Risk-adjusted AKI rates significantly reduced on re-audit, however, this was most likely due to factors separate from the local presentation of initial results.

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