Skip to main content
SpringerLink
Log in

Neonatal Acute Kidney Injury

  • Chapter
  • First Online:
Critical Care Pediatric Nephrology and Dialysis: A Practical Handbook

Abstract

Neonatal acute kidney injury (nAKI) is highly prevalent but the definition of nAKI remains nebulous. This is because we rely on serum creatinine (SCr) for the estimation of kidney function which is an indirect measure of muscle mass and the maternal placental transfer of SCr in the early post-natal period. Similarly, the physiological transition into the extra-uterine environment should result in a natural improvement in neonatal renal function from 25% to at least 60% of adult renal function within the first post-natal week. This should lead to a natural and steady decline in the SCr from birth to discharge. Neonatal AKI may be defined as a rise in SCr of >0.3 mg/dL, a peak in SCr ≥1.5 mg/dL and/or a “nadir” SCr at discharge ≥0.5 mg/dL. Importantly, infants born preterm and/or small for gestational age are more vulnerable to nAKI. Diagnosis, early medical intervention and longterm follow-up are essential for these individuals to avert the likely progression to chronic kidney disease including hypertension and cardiorenal disease with shortened longevity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D. Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res. 2011;69:354–8.

    Article  Google Scholar 

  2. Carmody JB, Swanson JR, Rhone ET, Charlton JR. Recognition and reporting of AKI in very low birth weight infants. Clin J Am Soc Nephrol. 2014;9:2036–43.

    Article  Google Scholar 

  3. Selewski DT, Charlton JR, Jetton JG, Guillet R, Mhanna MJ, Askenazi DJ, Kent AL. Neonatal acute kidney injury. Pediatrics. 2015;136(2):e463–73.

    Article  Google Scholar 

  4. Luyckx VA, Bertram LF, Brenner BM, Fall C, Hoy WE, Ozanne SE, Vikse BE. Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease. Lancet. 2013;382(9888):273–83.

    Article  Google Scholar 

  5. Askenazi DJ, Morgan C, Goldstein SL, Selewski DT, Moxey-Mims MM, Kimmel PL, Star RA, Higgins R, Laughon M. Strategies to improve the understanding of long-term renal consequences after neonatal acute kidney injury. Pediatr Res. 2016;79(3):502–8.

    Article  Google Scholar 

  6. Zappitelli M, Ambalavanan N, Askenazi DJ, Moxey-Mims MM, Kimmel PL, Star RA, Abitbol CL, Brophy PD, Hidalgo G, Hanna M, Morgan CM, Raju TNK, Ray P, Reyes-Bou Z, Roushdi A, Goldstein SL. Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop. Pediatr Res. 2017;82(4):569–73.

    Article  Google Scholar 

  7. Jetton JG, Guillet R, Askenazi DJ, Dill L, Jacobs J, Kent AL, Selewski DT, Abitbol CL, Kaskel FJ, Mhanna MJ, Ambalavanan N, Charlton JR, The Neonatal Kidney Collaborative. Assessment of worldwide acute kidney injury epidemiology in neonates: design of a retrospective cohort study. Front Pediatr. 2016;4:68.

    Article  Google Scholar 

  8. Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno D, Chishti AS, Woroniecki R, Mammen C, Swanson SR, Sridhar S, Wong CS, Kupferman JC, Griffin RL, Askenazi DJ, on behalf of the Neonatal Kidney Collaborative (NKC). Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health. 2017;1:184–94.

    Article  Google Scholar 

  9. Harer MW, Askenazi DJ, Boohaker LJ, Carmody JB, Griffin RL, Guillet R, Selewski DT, Swanson JR, Charlton JR, Neonatal Kidney Collaborative (NKC). Association between early caffeine citrate administration and risk of acute kidney injury in preterm neonates: results from the AWAKEN study. JAMA Pediatr. 2018;172:e180322. https://doi.org/10.1001/jamapediatrics.2018.0322.

    Article  PubMed  Google Scholar 

  10. Drukker A, Guignard J. Renal aspects of the term and preterm infant: a selective update. Curr Opin Pediatr. 2002;14:175–82.

    Article  Google Scholar 

  11. Rosenblum S, Pal A, Reidy K. Renal development in the fetus and premature infant. Semin Fetal Neonatal Med. 2017;22(2):58–66.

    Article  Google Scholar 

  12. Rodríguez MM, Gómez AH, Abitbol CL, Chandar JJ, Duara S, Zilleruelo GE. Histomorphometric analysis of postnatal glomerulogenesis in extremely preterm infants. Pediatr Dev Pathol. 2004;7(1):17–25.

    Article  Google Scholar 

  13. Sutherland MR, Gubhaju L, Moore L, Kent AL, Dahlstrom JE, Horne RS, Hoy WE, Bertram JF, Black MJ. Accelerated maturation and abnormal morphology in the preterm neonatal kidney. J Am Soc Nephrol. 2011;22(7):1365–74.

    Article  Google Scholar 

  14. Choker G, Gouyon JB. Diagnosis of acute renal failure in very preterm infants. Biol Neonate. 2004;86:212–6.

    Article  CAS  Google Scholar 

  15. Nada A, Bonachea EM, Askenazi DJ. Acute kidney injury in the fetus and neonate. Semin Fetal Neonatal Med. 2017;22(2):90–7.

    Article  Google Scholar 

  16. Kastl JT. Renal function in the fetus and neonate – the creatinine enigma. Semin Fetal Neonatal Med. 2017;22(2):83–9.

    Article  Google Scholar 

  17. Mian AN, Schwartz GJ. Measurement and estimation of glomerular filtration rate in children. Adv Chronic Kidney Dis. 2017;24(6):348–56.

    Article  Google Scholar 

  18. Abitbol CL, DeFreitas MJ, Strauss J. Assessment of kidney function in preterm infants: lifelong implications. Pediatr Nephrol. 2016;31(12):2213–22.

    Article  Google Scholar 

  19. Treiber M, Pecovnik Balon B, Gorenjak M. A new serum cystatin C formula for estimating glomerular filtration rate in newborns. Pediatr Nephrol. 2015;30:1297–305.

    Article  Google Scholar 

  20. Bruel A, Rozé JC, Quere MP, Flamant C, Boivin M, Roussey-Kesler G, Allain-Launay E. Renal outcome in children born preterm with neonatal acute renal failure: IRENEO-a prospective controlled study. Pediatr Nephrol. 2016;31(12):2365–73.

    Article  Google Scholar 

  21. Abitbol CL, Bauer CR, Montané B, Chandar J, Duara S, Zilleruelo G. Long-term follow-up of extremely low birth weight infants with neonatal renal failure. Pediatr Nephrol. 2003;18(9):887–93.

    Article  Google Scholar 

  22. Weintraub AS, Connors J, Carey A, Blanco V, Green RS. The spectrum of onset of acute kidney injury in premature infants less than 30 weeks gestation. J Perinatol. 2016;36(6):474–80.

    Article  CAS  Google Scholar 

  23. Askenazi DJ, Koralkar R, Patil N, Halloran B, Ambalavanan N, Griffin R. Acute kidney injury urine biomarkers in very low-birth-weight infants. Clin J Am Soc Nephrol. 2016;11(9):1527–35.

    Article  CAS  Google Scholar 

  24. Tóth-Heyn P, Drukker A, Guignard JP. The stressed neonatal kidney: from pathophysiology to clinical management of neonatal vasomotor nephropathy. Pediatr Nephrol Berl Ger. 2000;14(3):227–39.

    Article  Google Scholar 

  25. Gouyon JB, Guignard JP. Vasomotor kidney failure in the newborn infant. Physiopathology and treatment. Arch Fr Pediatr. 1989;46(2):137–41.

    CAS  PubMed  Google Scholar 

  26. Criss CN, Selewski DT, Sunkara B, Gish JS, Hsieh L, Mcleod JS, et al. Acute kidney injury in necrotizing enterocolitis predicts mortality. Pediatr Nephrol Berl Ger. 2018;33(3):503–10.

    Article  Google Scholar 

  27. Blinder JJ, Goldstein SL, Lee V-V, Baycroft A, Fraser CD, Nelson D, et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg. 2012;143(2):368–74.

    Article  Google Scholar 

  28. Polglase GR, Ong T, Hillman NH. Cardiovascular alterations and multiorgan dysfunction after birth asphyxia. Clin Perinatol. 2016;43(3):469–83.

    Article  Google Scholar 

  29. Jetton JG, Askenazi DJ. Acute kidney injury in the neonate. Clin Perinatol. 2014;41(3):487–502.

    Article  Google Scholar 

  30. Fanos V, Antonucci R, Zaffanello M, Mussap M. Neonatal drug induced nephrotoxicity: old and next generation biomarkers for early detection and management of neonatal drug-induced nephrotoxicity, with special emphasis on uNGAL and on metabolomics. Curr Med Chem. 2012;19(27):4595–605.

    Article  CAS  Google Scholar 

  31. Jetton JG, Sorenson M. Pharmacological management of acute kidney injury and chronic kidney disease in neonates. Semin Fetal Neonatal Med. 2017;22(2):109–15.

    Article  Google Scholar 

  32. Rees L. Renal replacement therapies in neonates: issues and ethics. Semin Fetal Neonatal Med. 2017;22(2):104–8.

    Article  Google Scholar 

  33. Askenazi D, Ingram D, White S, Koyner JL, Arthur JM, Shaw AD, et al. Smaller circuits for smaller patients: improving renal support therapy with Aquadex. Pediatr Nephrol. 2016;31:853e60.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neonatology, Case Western Reserve University, Neonatal Perinatal Medicine, MetroHealth Medical Center/Cleveland Clinic Foundation, Cleveland, OH, USA

    Indrani Bhattacharjee

  2. Clinical Pediatrics, Department of Pediatrics/Division of Pediatric Nephrology, Holtz Children’s Hospital/Jackson Memorial Hospital, Miami, FL, USA

    Marissa J. DeFreitas

  3. Pediatrics, Case Western Reserve University, Pediatric Critical Care and Neonatal Perinatal Medicine, MetroHealth Medical Center, Cleveland, OH, USA

    Maroun Mhanna

  4. Pediatrics, Pediatric Dialysis, University of Miami/Holtz Children’s Hospital, Miami, FL, USA

    Carolyn Abitbol

Authors
  1. Indrani Bhattacharjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marissa J. DeFreitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maroun Mhanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carolyn Abitbol
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carolyn Abitbol .

Editor information

Editors and Affiliations

  1. Kidney & Urology Institute, Medanta, The Medicity Kidney & Urology Institute, Gurugram, Haryana, India

    Sidharth Kumar Sethi

  2. Department of Nephrology, Cleveland Clinic Akron General Medical center and Akron Children’s Hospital, Akron, OH, USA

    Rupesh Raina

  3. Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa

    Mignon McCulloch

  4. Pediatric Nephrology, Children’s Hospital of Richmond at the Virginia Commonwealth University, Richmond, VA, USA

    Timothy E. Bunchman

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bhattacharjee, I., DeFreitas, M.J., Mhanna, M., Abitbol, C. (2019). Neonatal Acute Kidney Injury. In: Sethi, S., Raina, R., McCulloch, M., Bunchman, T. (eds) Critical Care Pediatric Nephrology and Dialysis: A Practical Handbook. Springer, Singapore. https://doi.org/10.1007/978-981-13-2276-1_14

Download citation

  • DOI: https://doi.org/10.1007/978-981-13-2276-1_14

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-2275-4

  • Online ISBN: 978-981-13-2276-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation