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Nishizaki N, Matsuda A, Yoneyama T, Watanabe A, Obinata K, Shimizu T. The influence on renal function of ibuprofen treatment for patent ductus arteriosus in extremely low birthweight infants. Pediatr Int 2020; 62:193-199. [PMID: 31756017 DOI: 10.1111/ped.14057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/04/2019] [Accepted: 10/29/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Ibuprofen (IBU) has been used recently for the treatment of patent ductus arteriosus (PDA) in Japan. We aimed to investigate the efficacy and adverse events of IBU and compare them with those of indomethacin (IND) as PDA treatment for extremely low-birthweight infants (ELBWIs), focusing on short-term renal function. METHODS A case-control study was conducted on 16 ELBWIs. The data from eligible patients were divided into two groups. Ten patients had undergone IND treatment (IND group) between January 2017 and June 2018, whereas six had undergone IBU treatment (IBU group) for PDA between July 2018 and December 2018. The IND group received 0.1 mg/kg/12h IND IV infusion for three doses, whereas the IBU group received 10 mg/kg IV IBU infusion followed by 5 mg/kg/day for 2 days. We compared the efficacy for PDA closure and renal impairment between the two groups. RESULTS No significant differences in primary closure rates and the PDA ligation required were observed between the two groups. No significant differences were observed between the incidence of intraventricular hemorrhage and gastrointestinal complications in both groups. Changes in urine volume (%) in the IBU group were significantly higher than in the IND group at 24-36 h post-administration. The urinary L-type fatty acid binding protein concentration level at 7 days of life was significantly lower in the IBU group than in the IND group. CONCLUSION Although IBU was comparable to IND in PDA closure rate, IBU was superior to short-term renal injury in ELBWIs.
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Affiliation(s)
- Naoto Nishizaki
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akina Matsuda
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Toshiyuki Yoneyama
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akiko Watanabe
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kaoru Obinata
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Raina R, Vijayaraghavan P, Kapur G, Sethi SK, Krishnappa V, Kumar D, Bunchman TE, Bolen SD, Chand D. Hemodialysis in neonates and infants: A systematic review. Semin Dial 2017; 31:289-299. [DOI: 10.1111/sdi.12657] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rupesh Raina
- Department of Nephrology; Cleveland Clinic Akron General/Akron Nephrology Associates; Akron OH USA
- Department of Pediatric Nephrology; Akron Children's Hospital; Akron OH USA
| | - Prashanth Vijayaraghavan
- Department of Nephrology; Cleveland Clinic Akron General/Akron Nephrology Associates; Akron OH USA
| | - Gaurav Kapur
- Pediatric Nephrology and Hypertension; Children's Hospital of Michigan; Detroit MI USA
| | - Sidharth Kumar Sethi
- Pediatric Nephrology & Pediatric Kidney Transplantation; Kidney and Urology Institute; Medanta, The Medicity Hospital; Gurgaon India
| | - Vinod Krishnappa
- Department of Nephrology; Cleveland Clinic Akron General/Akron Nephrology Associates; Akron OH USA
| | - Deepak Kumar
- Division of Pediatric Neonatology; MetroHealth Medical Center/Case Western Reserve University; Cleveland OH USA
| | - Timothy E. Bunchman
- Pediatric Nephrology & Transplantation; Children's Hospital of Richmond; Virginia Commonwealth University; Richmond VA USA
| | - Shari D Bolen
- Center for Health Care Research and Policy; Department of Medicine; Metro Health Medical Center/Case Western Reserve University; Cleveland OH USA
| | - Deepa Chand
- Division of Pediatric Nephrology; University of Illinois College of Medicine; Peoria IL USA
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Asinobi AO, Ademola AD, Alao MA. Haemodialysis for paediatric acute kidney injury in a low resource setting: experience from a tertiary hospital in South West Nigeria. Clin Kidney J 2015; 9:63-8. [PMID: 26798463 PMCID: PMC4720192 DOI: 10.1093/ckj/sfv112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/08/2015] [Indexed: 01/12/2023] Open
Abstract
Background Acute kidney injury (AKI) is an important cause of preventable mortality among children. Management of AKI may require renal replacement therapy (RRT) but access to RRT for children in low resource settings is limited. Our study explored the role of haemodialysis in the management of children with AKI in a low resource setting in terms of aetiology and outcomes. Methods A review of patients managed in the Paediatric Nephrology Unit, University College Hospital Ibadan, South-West Nigeria, who underwent haemodialysis for AKI from January 2006 to December 2014. Results Sixty-eight patients (55.9% males), aged 3–16 (mean ± standard deviation, 9.0 ± 3.4) years were studied. The causes of AKI were sepsis (22.1%), malaria (17.6%) and glomerulonephritis (17.6%), intravascular haemolysis—cause unknown (16.2%), G6PDH deficiency (7.4%), malignancy (8.8%) and haemoglobinopathy (5.9%). The number of sessions of haemodialysis ranged from 1 to 10 (mode = 2 sessions) over a period of 1–55 days. Mortality was 27.9% (n = 19) and was related to the aetiology of AKI (P = 0.000): no deaths among patients with intravascular haemolysis or malaria, six deaths among patients with sepsis (40%), six (50%) among the patients with glomerulonephritis, while all the patients with malignancies died. Conclusions The outcome of haemodialysis for AKI in Nigeria is relatively good and is related to the underlying aetiology of AKI. In addition to peritoneal dialysis, intermittent haemodialysis may have a role in the management of paediatric AKI in low resource settings and should be supported.
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Affiliation(s)
- Adanze O Asinobi
- Department of Paediatrics, College of Medicine, University of Ibadan, Oyo State, Nigeria; Department of Paediatrics, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Adebowale D Ademola
- Department of Paediatrics, College of Medicine, University of Ibadan, Oyo State, Nigeria; Department of Paediatrics, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Michael A Alao
- Department of Paediatrics , Bowen University Teaching Hospital , Ogbomoso, Oyo State , Nigeria
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Xing R, Liu S, Yu H, Qin Y, Chen X, Li K, Li P. Protective effect of sulfated chitosan of C3 sulfation on glycerol-induced acute renal failure in rat kidney. Int J Biol Macromol 2014; 65:383-8. [DOI: 10.1016/j.ijbiomac.2014.01.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/26/2013] [Accepted: 01/16/2014] [Indexed: 11/28/2022]
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Acute kidney injury in a single neonatal intensive care unit in Turkey. World J Pediatr 2013; 9:323-9. [PMID: 24235066 DOI: 10.1007/s12519-012-0371-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 08/15/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although advances in perinatal medicine have increased the survival rates of critically ill neonates, acute kidney injury (AKI) is still one of the major causes of mortality and morbidity in neonatal intensive care units. This study aimed to determine the prevalence of AKI and analyze demographic data and risk factors associated with the mortality or morbidity. METHODS Of 1992 neonates hospitalized between January 2009 and January 2011, 168 with AKI were reviewed in the study. The diagnosis of AKI was based on plasma creatinine level >1.5 mg/dL, which persists for more than 24 hours or increases more than 0.3 mg/dL per day after the first 48 hours of birth while showing normal maternal renal function. RESULTS The prevalence of AKI was 8.4%. The common cause of AKI was respiratory distress syndrome, followed by sepsis, asphyxia, dehydration, congenital anomalies of the urinary tract, congenital heart disease, and medication. The prevalence of AKI in neonates with birth weight lower than 1500 g was about three-fold higher than in those with birth weight higher than 1500 g (P<0.05). Pregnancy-induced hypertension, preterm prolonged rupture of membranes, and administration of antenatal corticosteroid were associated with increased risk of AKI (P<0.05). Umbilical vein catheterization, mechanical ventilation and ibuprofen therapy for patent ductus arteriosus closure were found to be associated with AKI (P<0.05). The overall mortality rate was 23.8%. Multivariate analysis revealed that birth weight less than 1500 g, mechanical ventilation, bronchopulmonary dysplasia, anuria, and dialysis were the risk factors for the mortality of infants with AKI. CONCLUSIONS Prenatal factors and medical devices were significantly associated with AKI. Early detection of risk factors can reduce the mortality of AKI patients.
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Abstract
UNLABELLED Acute kidney injury frequently develops following the term perinatal hypoxia-ischaemia. Quantifying the degree of acute kidney injury is difficult, however, as the methods currently in use are suboptimal. Acute kidney injury management is largely supportive with little evidence basis for many interventions. This review discusses management strategies and novel biomarkers that may improve diagnosis and management of renal injury following perinatal hypoxia-ischaemia. CONCLUSION Following perinatal hypoxia-ischaemia, acute kidney injury is common. Management of neonatal acute kidney injury is largely supportive. Novel acute kidney injury biomarkers may play a role in optimizing new categorical definitions of renal injury. Studies are needed to investigate the impact of neonatal acute kidney injury on long-term outcome.
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Lynch BA, Gal P, Ransom JL, Carlos RQ, Dimaguila MAVT, Smith MS, Wimmer JE, Imm MD. Low-dose aminophylline for the treatment of neonatal non-oliguric renal failure-case series and review of the literature. J Pediatr Pharmacol Ther 2012; 13:80-7. [PMID: 23055869 DOI: 10.5863/1551-6776-13.2.80] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Aminophylline is a methylxanthine with multiple physiologic actions. At low doses, aminophylline can antagonize adenosine and improve renal function via increased glomerular filtration rate. Despite its clinical use, little data exists in neonates for this indication. Therefore, the objective of this report is to describe the impact of aminophylline on renal function indices in a series of neonates with acute renal failure. MATERIALS AND METHODS This was a retrospective chart review of 13 neonates with acute renal failure who received aminophylline during a 15-month study period. Aminophylline was administered at 1 mg/kg intravenously or orally every twelve hours. Forty-six percent (n = 6) of the patients received a 5 mg/kg loading dose before initiation of maintenance therapy. Most patients had already received other treatments for renal failure, including diuretics and dopamine. RESULTS Resolution of acute renal failure (with normalization of serum creatinine and blood urea nitrogen) was documented in 10 patients (77%). Four of the thirteen patients died from complications due to their prematurity. Failure of low-dose aminophylline was observed in 3 of the 4 patients who died. CONCLUSIONS Low-dose aminophylline in neonates with acute renal failure is associated with an improvement in renal function indices.
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Affiliation(s)
- Bethany A Lynch
- Departments of Neonatal Medicine and Pharmacy, Women's Hospital, Greensboro, North Carolina
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Vachvanichsanong P, McNeil E, Dissaneevate S, Dissaneewate P, Chanvitan P, Janjindamai W. Neonatal acute kidney injury in a tertiary center in a developing country. Nephrol Dial Transplant 2011; 27:973-7. [PMID: 21956250 DOI: 10.1093/ndt/gfr477] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common contributor to morbidity and mortality in newborns, with prevalences varying by population and hospital. A study of AKI in newborns in tertiary care centers in Thailand, a developing country with limited resources, has not been conducted yet. METHODS The aim of this study was to determine the prevalence of AKI in newborns in a tertiary care hospital in southern Thailand and to investigate the etiology, mortality and risk factors of mortality. The records of patients aged <30 days with high serum creatinine, admitted from 1984 to 2007, were retrospectively reviewed. RESULTS Eighty-eight boys and 51 girls were enrolled; 61.4% were premature and 56.5% had a birth weight <2500 g. The prevalence of newborn AKI increased from 0.9 to 6.3% during the 24-year study period. Thirty-nine and 65% had renal failure within 2 and 7 days post-birth, respectively. Sepsis was the most common cause of AKI (30.9%) followed by hypovolemia (18.7%), kidney, ureter and bladder (KUB) anomalies (12.2%), congestive heart failure (12.2%) and birth asphyxia (11.5%). Indomethacin caused AKI in 24.4% with gestational age <32 weeks. Sepsis-induced AKI had the highest mortality rate (65.1%) with an overall mortality rate of 38.8% and nearly 14 times the risk of death compared to hypovolemia-induced AKI. CONCLUSIONS The prevalence of newborn AKI in our Thai tertiary center over 24 years was 6.3% of admitted newborns. Sepsis was the most common cause of AKI and sepsis-induced AKI is the most common cause of death. Disease etiology was the only risk factor for mortality.
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Affiliation(s)
- Prayong Vachvanichsanong
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
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Abstract
Acute kidney injury (AKI) is a common consequence of perinatal asphyxia, occurring in up to 56% of these infants. A major difficulty in diagnosing this condition is the lack of a consensus definition of neonatal AKI, largely because of a dearth of specific measurable variables and biochemical markers. This review will discuss the current evidence regarding the epidemiology, investigation, and treatment of AKI in the asphyxiated neonate. Particular emphasis will be given to the investigation of renal function in the neonate and to potential biomarkers that may aid the clinician in the diagnosis of renal injury in this population.
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Affiliation(s)
- Anne M Durkan
- Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Abstract
BACKGROUND/AIM Hemodynamic stress is the leading cause of acute renal failure (ARF) in premature neonates. Incidence of ARF in this population is between 8 and 24%. The aim of this study was to determine the frequence of presence of ARF in premature neonates, as well as its impact on their survival. METHODS A retrospective study of 114 premature neonates [(gestational age, GA less than 37 gestation weeks (gw)] admitted to the Intensive Care Unit (ICU) at the Pediatric Clinic, Institute of Child and Youth Healthcare of Vojvodina in 2007 was conducted. Serum creatinine, urea and bilirubine were determined on the 3rd day of life in 65 newborns who met inclusion criteria. ARF was diagnosed in 16 newborns (n = 16/65; 25%). RESULTS The premature neonates with ARF had significantly lower GA [<28 gw - 8/16 (50%) vs. 5/49 (10%); p < 0.05], birth weight (BW) (1265 g vs. 1615 g; p < 0.05) and systolic blood pressure (43.37 mm Hg vs. 52.7 mmHg; p < 0.05) than ones without ARF. Non-olyguric ARF was diagnosed in 62% of newborns with ARF (n = 10/16), while the rest had the olyguric type (n = 6/16; 38%). Twenty-five percent of premature neonates with ARF (n = 4/16) died in contrast to 10% of premature neonates without ARF (n = 5/49). ARF was treated conservatively in all but 3 cases when peritoneal dialysis was performed. Renal function has recovered completely in all of the survivors. In order to determine their predictivity in relation to ARF, following parameters were analyzed: GA, BW < 1500 g, presence of concomitant sepsis and intracranial hemorrhage grade III/IV. BW < 1500 g demonstrated the highest sensitivity (se 0.75), while GA < 28 gw, sepsis and intracranial hemorrhage grade III/IV showed high specificity (sp = 0.90, 0.89 0.88, respectively). CONCLUSION Acute renal failure frequently occurs in population of premature neonates and requires meticulous fluid and electrolyte balance, especially in the case of low birth weight and extreme immaturity.
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Ogunlesi TA, Adekanmbi F. Evaluating and managing neonatal acute renal failure in a resource-poor setting. Indian J Pediatr 2009; 76:293-6. [PMID: 19347669 DOI: 10.1007/s12098-009-0055-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 03/19/2008] [Indexed: 11/28/2022]
Abstract
Acute renal failure (ARF) is encountered in neonatal care where it may be associated with significant morbidities. Pre-renal failure, which is due to impaired renal tissue perfusion, is the commonest type of ARF. It is amenable to treatment with excellent prognosis following prompt diagnosis and timely institution of appropriate intervention. Unfortunately, ARF in the newborn is usually asymptomatic and it is only suspected when a newborn infant has not been observed to pass urine over several hours or when serum Creatinine is observed to be elevated or rising. In resource-poor settings, it is often difficult to conduct detailed evaluation of suspected cases of newborn ARF due to lack of appropriate equipments and infrastructure. Similarly, therapeutic facilities are sparse and there is heavy reliance on conservative management of cases. Such difficulties encountered in the evaluation and management of newborns with ARF in most parts of the developing world, like Nigeria, where diagnostic and therapeutic facilities are limited are highlighted.
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Affiliation(s)
- Tinuade A Ogunlesi
- Department of Pediatrics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria.
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Affiliation(s)
- Hyewon Hahn
- Department of Pediatrics, Eulji University School of Medicine, Daejeon, Korea
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