Acute kidney failure in neonatal period

ABSTRACT

Acute kidney failure [AKF] is a common clinical problem in neonatal intensive care units and is usually associated with a contributing condition such as sepsis, asphyxia, and heart failure. The aim of this study was to determine the types, frequency of associated contributing conditions, and short-term outcome of neonatal AKF. Medical records of neonates with a diagnosis of AKF from March 2003 to September 2006 were studied in a tertiary care children's hospital in Tabriz, Iran. Of 6042 hospitalized neonates, 151 with documented AKF [100 boys and 51 girls] were reviewed in the study. Ninety-one patients [60.3%] had been referred from other cities. Fifty-seven patients [37.7%] developed AKF following a surgery. Causes of AKF were intrinsic kidney failure in 52.3%, prerenal in 42.4%, and postrenal in 5.3%. Oliguria was observed in 72.2% of the patients. Perinatal asphyxia was present in 29.8% of the neonates, sepsis in 28.5%, respiratory distress syndrome in 25.2%, dehydration in 24.2%, and heart failure in 21.2%. Most patients [85.4%] had more than 1 associated contributing condition. Mortality rate was 20.5%. Most patients [76.2%] were discharged with normal kidney function and 3.3% with diminished kidney function. Initial admission to NICU, female sex, septicemia, and the need for mechanical ventilation were associated with a higher mortality rate. The frequency of associated contributing conditions and short-term outcome of neonatal AKF in our institution is comparable with other studies; however, intrinsic kidney failure comprises the most common form of AKF in our patients