Acute Renal Failure in Neonatal Period

AIM: Acute renal failure (ARF) is an important clinical problem
in the neonatal period and usually related with a primary disease.
Unless diagnosed early and treated properly, it may cause significant mortality and morbidity. In this study, we reviewed the clinical
characteristics and prognostic risk factors of ARF patients followed
up in our Neonatal Intensive Care Unit.

PATIENTS and METHODS: One
thousand and ninety four patients were followed up in the Neonatal
Intensive Care Unit between January 2000 and January 2005. Thirtytwo of these patients (3%) were diagnosed as ARF with the criteria
of doubling serum creatinine level or serum creatinine level expanding 1.5 mg/dL. Birth weight, gestational age, age at diagnosis of
ARF, causes of ARF, presence of perinatal risk factors, serum creatinine levels, course of ARF, need for inotropic agents, need for dialysis and other organ involvement were noted.

RESULTS: Twenty-four of
the babies were preterm babies (75%) and 13 were very low birth
weight babies. The mean birth weight and gestational age of the babies were 1924 ± 927 g and 32.9 ± 4.9 weeks, respectively. Causes of
ARF were prerenal in 28 cases (87%), renal in 3 cases (10%) and postrenal in 1 case (3%). Perinatal risk factors were present in 17 of the
patients (53%). The median age of diagnosis and the median serum
creatinine concentration were 5 days and 1.5 mg/dL, respectively.
The clinical course of ARF was nonoliguric in 21 cases. Five patients
needed dialysis therapy. Ten patients died with a mortality rate of
31%. The comparison of survivors and nonsurvivors showed that
prematurity, very low birth weight, need for inotropic treatment,
mechanical ventilation, the need for dialysis and other organ involvement were significantly important prognostic risk factors.

CONCLUSION: Neonatal ARF is usually prerenal in origin. Perinatal risk factors are present in half of the cases. Mortality is high (31%).
Prematurity, very low birth weight, hemodynamic instability, need
for dialysis and other organ involvement are prognostic risk factors.