Download PDF
CC BY 4.0 · Journal of Child Science 2023; 13(01): e104-e112
DOI: 10.1055/s-0043-1771517
Original Article

Early Predictor of Acute Kidney Injury in Newborns with Perinatal Asphyxia

Nafisa Hassan Refat 
1   Department of Pediatrics, Assiut University Children's Hospital, Assiut, Egypt
,
Mohamed Amir Fathy 
1   Department of Pediatrics, Assiut University Children's Hospital, Assiut, Egypt
,
Ali Hamdy Ali Abdel Hafez 
2   Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
,
Mohammed Abdeltawab Sabra 
1   Department of Pediatrics, Assiut University Children's Hospital, Assiut, Egypt
,
Enas Ahmad Hamed 
3   Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt
,
Yasser Farouk Abdelraheem 
1   Department of Pediatrics, Assiut University Children's Hospital, Assiut, Egypt
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Acute 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.

Keywords

acute kidney injury - accuracy - cystatin C - perinatal asphyxia - neonates

Authors' Contribution

N.H.R., M.A.F. and Y.F.A. conceptualized the work, analyzed, and interpreted, drew and reviewed the first draft and ensured for the integrity and accuracy in the work. A.H.A.A.H. and E.A.H. conceptualized the work, software, validation, visualization, investigation, reviewed the first draft, and ensured for the integrity and accuracy in the work. M.A.S. contributed to data curation, writing—original draft preparation, and ensured for the integrity and accuracy in the work. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. These authors contributed equally to this work.




Publication History

Received: 07 April 2023

Accepted: 28 June 2023

Article published online:
02 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Friedlich PS, Evans JR, Tulassay T, Seri I. . Acute and chronic renal failure. In: Avery's Diseases of the Newborn. WB Saunders; 2005:1298–1306
  • 2 Liava'a MH, Krishnamurthy G, Chai PJ. Low birth weight and other high-risk conditions. Critical Heart Disease Infants Children 2019; x: 371-378
    CrossrefPubMedGoogle Scholar
  • 3 Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012; 81 (05) 442-448
    CrossrefPubMedGoogle Scholar
  • 4 Levene M. . Perinatal asphyxia and Hypoxic-ischemic encephalopathy. Forfar and Arneil's Textbook of Pediatrics. 6th edition. Philadelphia: Churchill Livingstone, an Imprint of Elsevier Ltd.; 2003:197–204
  • 5 Popescu MR, Panaitescu AM, Pavel B, Zagrean L, Peltecu G, Zagrean A-M. Getting an early start in understanding perinatal asphyxia impact on the cardiovascular system. Front Pediatr 2020; 8 (68) 68
    CrossrefPubMedGoogle Scholar
  • 6 Oncel MY, Canpolat FE, Arayici S, Alyamac Dizdar E, Uras N, Oguz SS. Urinary markers of acute kidney injury in newborns with perinatal asphyxia (.). Ren Fail 2016; 38 (06) 882-888
    CrossrefPubMedGoogle Scholar
  • 7 Durkan AM, Alexander RT. Acute kidney injury post neonatal asphyxia. J Pediatr 2011; 158 (2, Suppl): e29-e33
    CrossrefPubMedGoogle Scholar
  • 8 Nishijima T, Kawasaki Y, Ueno K, Inomata S, Yoshida T. Renal impairment following perinatal asphyxia. Pediatr Neonatol 2021; 62 (04) 451-452
    CrossrefPubMedGoogle Scholar
  • 9 Selewski DT, Charlton JR, Jetton JG. et al. Neonatal acute kidney injury. Pediatrics 2015; 136 (02) e463-e473
    CrossrefPubMedGoogle Scholar
  • 10 Herget-Rosenthal S, Marggraf G, Hüsing J. et al. Early detection of acute renal failure by serum cystatin C. Kidney Int 2004; 66 (03) 1115-1122
    CrossrefPubMedGoogle Scholar
  • 11 Askenazi DJ, Ambalavanan N, Goldstein SL. Acute kidney injury in critically ill newborns: what do we know? What do we need to learn?. Pediatr Nephrol 2009; 24 (02) 265-274
    CrossrefPubMedGoogle Scholar
  • 12 Nada A, Bonachea EM, Askenazi DJ. Acute Kidney Injury in the Fetus and Neonate. Elsevier; 2017. :22(02):90–97
    CrossrefGoogle Scholar
  • 13 Hidayati EL, Utami MD, Rohsiswatmo R, Tridjaja B. Cystatin C compared to serum creatinine as a marker of acute kidney injury in critically ill neonates. Pediatr Nephrol 2021; 36 (01) 181-186
    PubMedGoogle Scholar
  • 14 Kandasamy Y, Smith R, Wright IM. Measuring cystatin C to determine renal function in neonates. Pediatr Crit Care Med 2013; 14 (03) 318-322
    CrossrefPubMedGoogle Scholar
  • 15 El-Gammacy TM, Shinkar DM, Mohamed NR, Al-Halag AR. Serum cystatin C as an early predictor of acute kidney injury in preterm neonates with respiratory distress syndrome. Scand J Clin Lab Invest 2018; 78 (05) 352-357
    CrossrefPubMedGoogle Scholar
  • 16 Krawczeski CD, Vandevoorde RG, Kathman T. et al. Serum cystatin C is an early predictive biomarker of acute kidney injury after pediatric cardiopulmonary bypass. Clin J Am Soc Nephrol 2010; 5 (09) 1552-1557
    CrossrefPubMedGoogle Scholar
  • 17 Boskabadi H, Omidian M, Tavallai S. et al. Serum Hsp70 antigen: early diagnosis marker in perinatal asphyxia. Iran J Pediatr 2015; 25 (02) e381
    CrossrefPubMedGoogle Scholar
  • 18 Coleman C, Tambay Perez A, Selewski DT, Steflik HJ. Neonatal acute kidney injury. Front Pediatr 2022; 10: 842544
    CrossrefPubMedGoogle Scholar
  • 19 Leem AY, Park MS, Park BH. et al. Value of serum cystatin C measurement in the diagnosis of sepsis-induced kidney injury and prediction of renal function recovery. Yonsei Med J 2017; 58 (03) 604-612
    CrossrefPubMedGoogle Scholar
  • 20 Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33 (10) 696-705
    CrossrefPubMedGoogle Scholar
  • 21 Gupta BD, Sharma P, Bagla J, Parakh M, Soni JP. Renal failure in asphyxiated neonates. Indian Pediatr 2005; 42 (09) 928-934
    PubMedGoogle Scholar
  • 22 Mehrkesh M, Barekatain B, Gheisari A, Ahmadi M, Shahsanai A. Serum KIM-1 and cystatin levels as the predictors of acute kidney injury in asphyxiated neonates. Iranian Journal of Neonatology 2022; 13 (01) 6-12
    PubMedGoogle Scholar
  • 23 Askenazi DJ, Ambalavanan N, Goldstein SL. Acute kidney injury in critically ill newborns: what do we know? What do we need to learn?. Pediatr Nephrol 2009; 24 (02) 265-274
    CrossrefPubMedGoogle Scholar
  • 24 Bozkurt O, Yucesoy E. Acute kidney injury in neonates with perinatal asphyxia receiving therapeutic hypothermia. Am J Perinatol 2021; 38 (09) 922-929
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Jetton JG, Boohaker LJ, Sethi SK. et al; 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 (03) 184-194
    CrossrefPubMedGoogle Scholar
  • 26 Memon IA, Qudus HA, Waraich IS, Channa S, Marwat A, Lahrasab W. Acute kidney injury in neonates with birth asphyxia at a tertiary care hospital. Pak J Med Health Sci 2021; 15 (03) 573-575
    PubMedGoogle Scholar
  • 27 Alaro D, Bashir A, Musoke R, Wanaiana L. Prevalence and outcomes of acute kidney injury in term neonates with perinatal asphyxia. Afr Health Sci 2014; 14 (03) 682-688
    CrossrefPubMedGoogle Scholar
  • 28 Medani SA, Kheir AE, Mohamed MB. Acute kidney injury in asphyxiated neonates admitted to a tertiary neonatal unit in Sudan. Sudan J Paediatr 2014; 14 (02) 29-34
    PubMedGoogle Scholar
  • 29 Chishty AL, Iqbal MA, Anjum A, Maqbool S. Risk factor analysis of birth asphyxia at the children's hospital, Lahore. Pak Pediatr J 2002; 26: 47-53
    PubMedGoogle Scholar
  • 30 Malik TS, Chishti AL, Ahmed TM. Short term neurodevelopmental outcome of asphyxiated newborns at tertiary care unit. Pak Pediatr J 2007; 31 (02) 58-61
    PubMedGoogle Scholar
  • 31 Afzal MF, Anjum A, Sultan MA. Risk factor analysis in asphyxiated newborns and their outcome in relation to stage of hypoxic ischemic encephalopathy. Pak Pediatr J 2007; 31 (02) 63-68
    PubMedGoogle Scholar
  • 32 Hidayati EL, Utami MD, Rohsiswatmo R, Tridjaja B. Cystatin C compared to serum creatinine as a marker of acute kidney injury in critically ill neonates. Pediatr Nephrol 2021; 36 (01) 181-186
    CrossrefPubMedGoogle Scholar
  • 33 Gohiya P, Nadkarni J, Mishra M. Study of neonatal acute kidney injury based on KDIGO criteria. Pediatr Neonatol 2022; 63 (01) 66-70
    CrossrefPubMedGoogle Scholar
  • 34 Viswanathan S, Manyam B, Azhibekov T, Mhanna MJ. Risk factors associated with acute kidney injury in extremely low birth weight (ELBW) infants. Pediatr Nephrol 2012; 27 (02) 303-311
    CrossrefPubMedGoogle Scholar
  • 35 Cataldi L, Leone R, Moretti U. et al. Potential risk factors for the development of acute renal failure in preterm newborn infants: a case-control study. Arch Dis Child Fetal Neonatal Ed 2005; 90 (06) F514-F519
    CrossrefPubMedGoogle Scholar
  • 36 El-Gamasy MA, Nassar MAE. Risk factors for acute kidney injury (AKI) in newly born infants with hypoxic ischemic encephalopathy (HIE). A single center experience. Int J Res Stud Med Health Sci 2017; 2: 1-8
    PubMedGoogle Scholar
  • 37 Momtaz HE, Sabzehei MK, Rasuli B, Torabian S. The main etiologies of acute kidney injury in the newborns hospitalized in the neonatal intensive care unit. J Clin Neonatol 2014; 3 (02) 99-102
    CrossrefPubMedGoogle Scholar
  • 38 Bardallo Cruzado L, Pérez González E, Martínez Martos Z. et al. Serum cystatin C levels in preterm newborns in our setting: correlation with serum creatinine and preterm pathologies [in English]. Nefrologia 2015; 35 (03) 296-303
    PubMedGoogle Scholar
  • 39 Treiber M, Gorenjak M, Pecovnik Balon B. Serum cystatin-C as a marker of acute kidney injury in the newborn after perinatal hypoxia/asphyxia. Ther Apher Dial 2014; 18 (01) 57-67
    CrossrefPubMedGoogle Scholar
  • 40 Ahmed AM, Koura HM, Youssef H. et al. Early detection of neonatal kidney disease in high risk neonates admitted to neonatal intensive care unit. World J Med Sci 2014; 11: 518-524
    PubMedGoogle Scholar