| Abstract|| |
A retrospective multicenter study of 38 cases of acute renal failure (ARF) in newborns was carried out from April 1992 to September 1995 in the pediatric department so f a group hospitals of he Royal Medical Services in Jordan, to evaluate the etiology and the mortality rate in the first month of life. ARF was diagnosed according to the urine out put, serum level of creatinine and blood urea nitrogen. Neonatal asphyxia, the most common cause in this study, accounted for 42% (N=16) of renal failure and was associated with the highest mortality rate 70% (N=11). Drugs (aminoglycosides or vancomycin), the second most common cause of renal failure, accounted for 14% (N=7), but no patient sided. Septicemia accounted for 15.7% (N=6) of renal failure; one patients died. Three cases were due to genitorreal anomalies, one died with real agenesis. The other six cases were of different causes, four of them died. None of the newborns was treated by dialysis. We conclude that neonatal asphyxia is the most common cause of ARF in our series, and it carries poor prognosis. However, drug induced ARF has relatively good prognosis. The overall prognosis of ARF in the newborn was rather poor, the cumulative mortality, without dialysis, being of ARF in the newborn was rather poor, the cumulative mortality, without dialysis, being 45% in this study.
Keywords: Acute renal failure, Mortality, Etiology, Jordan.
|How to cite this article:|
Abu-Haweleh AFM. Acute Renal Failure in Newborn: Etiology and Mortality Rate in Jordan Patients. Saudi J Kidney Dis Transpl 1998;9:18-21
|How to cite this URL:|
Abu-Haweleh AFM. Acute Renal Failure in Newborn: Etiology and Mortality Rate in Jordan Patients. Saudi J Kidney Dis Transpl [serial online] 1998 [cited 2013 May 20];9:18-21. Available from: http://www.sjkdt.org/text.asp?1998/9/1/18/39296
| Introduction|| |
Incidence of acute renal failure is increasing among neonates, this is partly because of increases awareness of the possibility of renal failure ,, , partly because better management in associated with longer survival  , and partly from the use of drugs that may have a profound effect on renal function and perfusion  . In this study, we evaluate retrospectively the causes and outcome of neonatal ARF I a multicenter study in Jordan.
| Patients and Methods|| |
The study group was comprised of newborn babies who were diagnosed to have renal failure in the period from April 1992 to September 1995 in the pediatric departments of group hospitals of the Royal Medical Services in Jordan. Data were reviewed retrospectively from the hospital records.
ARF was defined as anuria (no urine voided for at least 24h) or documented ologuria less than 1 ml/kg/hr together with either blood urea nitrogen concentration of ore than 40 mg/dl (14.3 mol/L) or serum creatinine concentration of more than 1.5 mg/dl (133 µmol) with normal maternal renal function. Patients were considered to have nonoliguric renal failure if urine output was more than 1 ml/kg/hour.
We chose both apgar score of 5 or less at 5 minute of age, symptoms and signs of hypoxic-ishemic encephalopathy as inclusion criteria for ARF in asphyxiated newborn.
All patients were treated conservatively. Peritoneal dialysis was not performed in any of the patients due to the lack of experience in neonates.
| Results|| |
Thirty eight newborn babies were studies. The mean gestational age of the group was 37.6 weeks and the mean birth weight was 1900 gm; twelve were born prematurely, however, one was less than 28 weeks of gestation. The mean age of onset of ARF was 5.6 day.
Analysis showed that the babies could be divided into five groups according to etiology of renal failure. Asphyxia, drug toxicit, septicemia, genitorenal anomalies and miscellaneous, [Table - 1].
Sixteen patients had asphyxia. Eleven patients gied in this group and none was offered peritoneal dialysis.
Six patients were treated with aminoglycoside; one patient treated with vancomycin. All patients survived and showed dramatic improvement after discontinuing, modifying the dose, or changing to a nonnephrotoxoc antvbiotic.
Organisms were grown from blood culture of four septicemic babies. Two patients were diagnosed as having septicemia on clinical grounds in association with leucopenia. One patient died in this group.
Three patients were diagnosed post natal as having genitorenal anomalies, one died, while the other two survived the neonatal period with conservative treatment including surgical correction of posterior urethral valve in one of hem.
Six patients had miscellaneous etiologies of renal failure; two patients has necrotizing enterocolitis; two had circulatory collapse associates either idiopathic respiratory distress syndrome; one had disseminated intravascular coagulation, and one had heart failure due to left hypoplastic heart syndrome.
In most cases of acute renal failure in neonates, mortality was related to the underlying disease rather than the renal failure. [Table - 2] shows the major causes of death in different study sub-groups.
| Discussion|| |
Acute renal failure occurs in as many as 8% of neonates admitted to neonatal intensive care units  . The diagnosis of renal failure is not usually straightforward because it occurs in the context of complicated clinical conditions. For these reasons we looked at a combination of three criteria associated with acute renal failure urine output, biochemical indices (blood urea nitrogen and creatinine level) and the underlying etiology.
The average mortality is 70% in asphyxia associated with oliguric ARF ,, . Some studies did not show significant correlation between Apgar score at 5 and 10 minutes and the development of ARF  . Furthermore, the mortality rate is lower in the non-oliguric ARF patients secondary to asphyxia. As per Grylack et al  who reported seven cases of ARF secondary to asphyxia, respiratory distress syndrome and hypoxia, all were non-oliguric and all survived. Similar outcome was reported by others  . In our study 62% of the asphyxiated newborn had oliguric ARF, with 80% mortality rate in the oliguric subgroup. Our selection criteria of the asphyxiated patients may explain the oliguria and higher mortality rate (low apgar score) on this subgroup.
Nearly 15% neonates with septicemia are reported to develop ARF which is predominantly oliguric  . In our study 67% of the septicemic patients were oliguric and 33% were non-oliguric. However, the mortality rate was low (17%) in comparison with previous studies  . This low mortality rate could be explained by either early diagnosis and early treatment or the small number of the study patients.
In our study, genitorenal anomalies were associated with mortality in one patient with bilateral renal agenesis, while the other two bilateral renal agenesis, while the other two survived. Clinical follow yup may show residual renal damage especially in polycystic kidney disease as those patients carry higher mortality rate  . ARF associated with necrotizing enterocolitis, disseminated intravascular coagulation and shock secondary to congenital heart disease had high mortality rate.
The over all mortality rate was 45%, which is consistent with other reported mortality rates of 14-73% , . Although peritoneal dialysis is a safe and effective procedure in managing neonates with ARF, none of our patients had dialysis therapy.
We conclude that, neonatal asphyxia was the most common cause of ARF in our series, which was predominately of liguric type, and it carried poor prognosis. Drug induced ARF had a relatively good prognosis.
| Acknowledgment|| |
I thank Dr. Zeid Abdellatif and Dr. Issa Hazza for their help and for allowing me to report their patients.
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Abdel-Fatah Mohd Abu-Haweleh
King Hussein Medical Center, Swaileh, P.O. Box 828, Amman 11910
[Table - 1], [Table - 2]