Acute renal failure in cases at perinatal asphyxia

ABSTRACT

Acute renal failure in the neonates usually occurs following complicated delivery with perinatal hypoxia and shock. In our study, 41 neonates who suffered perinatal asphyxia and needed admission to the Neonatal Intensive Care Unit of Cairo University, were investigated for the detection of occurrence of acute renal failure. 15 normal infants were included as controls. Out of the 41 cases, 11 asphyxiated babies developed renal impairment suggestive of acute renal failure [26.8%]. Mean serum urea was significantly higher both in preterm [47.65 +/- 23.7 mg/dl] and term infants [61.47 +/- 55.6 mg/dl] than in control cases [24.5 +/- 7.69 mg/dl]. It was also significantly higher in cases who developed acute renal failure [111.9 +/- 45.7 mg/dl] than those cases without failure [33.7 +/- 12.5 mg/dl]. Mean serum creatinine was also significantly higher in asphyxiated babies [0.96 +/- .35 mg/dl in preterms and 1.005 +/- 0.432mg/dI in full terms] than in control eases 0.813 +/- 0.178] mean serum sodium was significantly lower in preterm and full term cases [129.2 +/- 12.02 mEq/I and 130.5 +/- 12.23 mEq/l]. This hyponatremia is explained by the inappropriate secretion of antidiuretic hormone secondary to hypoxIa insult to the central nervous system. Hyperkalemia occurred in 75% of asphyxiated babies [7.49 +/- 2.815 in preterm and 7.55 +/- 2.59 mEq/l in term cases]. Urinary casts [hyaline and granular] with many epithelial cells were found in 60% of cases. Convulsions were reported more frequently in the asphyxiated infants with renal failure. Hypoxia, uremia and hyponatremia were the contributary factors of the occurrence of convulsions. Abnormal ultrasound findings in the form of enlarged kidney size and increased pyramid echogenicity were reported. Prevention of perinatal asphyxia and prompt postnatal ressuscitation should be the cornerstone in avoiding and minimizing renal damage. Non invasive investigation tooIs as simplc urine analysis and abdominal utlrasonography are greatly valuable for the early diagnosis of acute renal damage in these asphyxiated neonates