PDF(1331 KB)
PDF(1331 KB)
PDF(1331 KB)
早产儿肾损伤及监测
Monitoring of kidney injury in preterm infants
急性肾损伤（AKI）是新生儿重症监护病房常见的并发症，不仅造成早产儿高病死率，还引起成年后多种慢性肾疾病。早产儿出生时肾脏发育不成熟，在生后特定时间窗内肾脏持续加速发育，但受孕期和产后多种因素影响，容易发生急性肾损伤。目前传统的评价肾损伤的指标为血清肌酐和尿量，但其早期敏感性和特异性问题日渐受到关注。最近多种新的生物学标志物被发现可用来早期识别急性肾损伤，本文就早产儿急性肾损伤、影响因素及肾功能评价和防治进行概述，为提高早产儿急性肾损伤早期诊治水平和远期生存质量提供参考。
Acute kidney injury (AKI) is a common complication in the neonatal intensive care unit that causes a high mortality of preterm infants and various chronic kidney diseases in adulthood. Preterm infants have immature development of the kidneys at birth. The kidneys continue to develop within a specific time window after birth. However, due to various factors during pregnancy and after birth, preterm infants tend to develop AKI. At present, serum creatinine and urine volume are used for the assessment of kidney injury, and their early sensitivity and specificity have attracted increasing attention. In recent years, various new biomarkers have been identified for early recognition of AKI. This article reviews the features, risk factors, renal function assessment, and prevention/treatment of AKI of preterm infants, in order to provide a reference for improving early diagnosis and treatment of AKI in preterm infants and long-term quality of life.
[1] Stritzke A, Thomas S, Amin H, et al. Renal consequences of preterm birth[J]. Mol Cell Pediatr, 2017, 4(1):2.
[2] Hartman HA, Lai HL, Patterson LT. Cessation of renal morphogenesis in mice[J]. Dev Biol, 2007, 310(2):379-387.
[3] Jetton JG, Askenazi DJ. Acute kidney injury in the neonate[J]. Clin Perinatol, 2014, 41(3):487-502.
[4] Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate[J]. Curr Opin Pediatr, 2012, 24(2):191-196.
[5] Stojanovi? V, Bariši? N, Milanovi? B, et al. Acute kidney injury in preterm infants admitted to a neonatal intensive care unit[J]. Pediatr Nephrol, 2014, 29(11):2213-2220.
[6] Doyle JF, Forni LG. Acute kidney injury:short-term and long-term effects[J]. Critical Care, 2016, 20(1):1-7.
[7] Carmody JB, Swanson JR, Rhone ET, et al. Recognition and reporting of AKI in very low birth weight infants[J]. Clin J Am Soc Nephrol, 2014, 9(12):2036-2043.
[8] Viswanathan S, Manyam B, Azhibekov T, et al. Risk factors associated with acute kidney injury in extremely low birth weight (ELBW) infants[J]. Pediatr Nephrol, 2012, 27(2):303-311.
[9] Mammen C, Al AA, Skippen P, et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit:a prospective cohort study[J]. Am J Kidney Dis, 2012, 59(4):523-530.
[10] Schiffl H, Fischer R. Five-year outcomes of severe acute kidney injury requiring renal replacement therapy[J]. Nephrol Dial Transplant, 2008, 23(7):2235-2241.
[11] Gallagher M, Cass A, Bellomo R, et al. Long-term survival and dialysis dependency following acute kidney injury in intensive care:extended follow-up of a randomized controlled trial[J]. PLoS Med, 2014, 11(2):e1001601.
[12] Mohamed GB, Ibrahiem MA, Abdel Hameed WM. Nephrocalcinosis in pre-term neonates:a study of incidence and risk factors[J]. Saudi J Kidney Dis Transpl, 2014, 25(2):326-332.
[13] Giapros V, Tsoni C, Challa A, et al. Renal function and kidney length in preterm infants with nephrocalcinosis:a longitudinal study[J]. Pediatr Nephrol, 2011, 26(10):1873-1880.
[14] Simonetti GD, Raio L, Surbek D, et al. Salt sensitivity of children with low birth weight[J]. Hypertension, 2008, 52(4):625-630.
[15] Starzec K, Klimek M, Grudzień A, et al. Longitudinal assessment of renal size and function in extremely low birth weight children at 7 and 11 years of age[J]. Pediatr Nephrol, 2016, 31(11):2119-2126.
[16] Carmody JB, Charlton JR. Short-term gestation, long-term risk:prematurity and chronic kidney disease[J]. Pediatrics, 2013, 131(6):1168-1179.
[17] Sutherland MR, Gubhaju L, Moore L, et al. Accelerated maturation and abnormal morphology in the preterm neonatal kidney[J]. J Am Soc Nephrol, 2011, 22(7):1365-1374.
[18] Gubhaju L, Sutherland MR, Yoder BA, et al. Is nephrogenesis affected by preterm birth? Studies in a non-human primate model[J]. Am J Physiol Renal Physiol, 2009, 297(6):F1668-F1677.
[19] Rhone ET, Carmody JB, Swanson JR, et al. Nephrotoxic medication exposure in very low birth weight infants[J]. J Matern Fetal Neonatal Med, 2014, 27(14):1485-1490.
[20] Selewski DT, Charlton JR, Jetton JG, et al. Neonatal acute kidney injury[J]. Pediatrics, 2015, 136(2):e463-e473.
[21] Ojeda NB, Grigore D, Alexander BT. Intrauterine growth restriction:fetal programming of hypertension and kidney disease[J]. Adv Chronic Kidney Dis, 2008, 15(2):101-106.
[22] Saint-Faust M, Boubred F, Simeoni U. Renal development and neonatal adaptation[J]. Am J Perinatol, 2014, 31(9):773-780.
[23] Cuzzolin L, Fanos V, Pinna B, et al. Postnatal renal function in preterm newborns:a role of diseases, drugs and therapeutic interventions[J]. Pediatr Nephrol, 2006, 21(7):931-938.
[24] Rosenblum S, Pal A, Reidy K. Renal development in the fetus and premature infant[J]. Semin Fetal Neonatal Med, 2017, 22(2):58-66.
[25] Selewski DT, Jordan BK, Askenazi DJ, et al. Acute kidney injury in asphyxiated newborns treated with therapeutic hypothermia[J]. J Pediatr, 2013, 162(4):725-729.e1.
[26] Alaro D, Bashir A, Musoke R, et al. Prevalence and outcomes of acute kidney injury in term neonates with perinatal asphyxia[J]. Afr Health Sci, 2014, 14(3):682-688.
[27] Askenazi D, Patil NR, Ambalavanan N, et al. Acute kidney injury is associated with bronchopulmonary dysplasia/mortality in premature infants[J]. Pediatr Nephrol, 2015, 30(9):1511-1518.
[28] Sarafidis K, Tsepkentzi E, Agakidou E, et al. Serum and urine acute kidney injury biomarkers in asphyxiated neonates[J]. Pediatr Nephrol, 2012, 27(9):1575-1582.
[29] Criss CN, Selewski DT, Sunkara B, et al. Acute kidney injury in necrotizing enterocolitis predicts mortality[J]. Pediatr Nephrol, 2018, 33(3):503-510.
[30] Sutherland MR, Yoder BA, McCurnin D, et al. Effects of ibuprofen treatment on the developing preterm baboon kidney[J]. Am J Physiol Renal Physiol, 2012, 302(10):F1286-F1292.
[31] Wintour EM, Moritz KM, Johnson K, et al. Reduced nephron number in adult sheep, hypertensive as a result of prenatal glucocorticoid treatment[J]. J Physiol, 2003, 549(Pt 3):929-935.
[32] Finken MJ, Keijzer-Veen MG, Dekker FW, et al. Antenatal glucocorticoid treatment is not associated with long-term metabolic risks in individuals born before 32 weeks of gestation[J]. Arch Dis Child Fetal Neonatal Ed, 2008, 93(6):F442-F447.
[33] Libório AB, Branco KM, Torres de Melo Bezerra C. Acute kidney injury in neonates:from urine output to new biomarkers[J]. Biomed Res Int, 2014, 2014:601568.
[34] Nada A, Bonachea EM, Askenazi DJ. Acute kidney injury in the fetus and neonate[J]. Semin Fetal Neonatal Med, 2017, 22(2):90-97.
[35] Li Y, Fu C, Zhou X, et al. Urine interleukin-18 and cystatin-C as biomarkers of acute kidney injury in critically ill neonates[J]. Pediatr Nephrol, 2012, 27(5):851-860.
[36] Elmas AT, Tabel Y, Elmas ON. Serum cystatin C predicts acute kidney injury in preterm neonates with respiratory distress syndrome[J]. Pediatr Nephrol, 2013, 28(3):477-484.
[37] Kashani K, Cheungpasitporn W, Ronco C. Biomarkers of acute kidney injury:the pathway from discovery to clinical adoption[J]. Clin Chem Lab Med, 2017, 55(8):1074-1089.
[38] Kuribayashi R, Suzumura H, Sairenchi T, et al. Urinary neutrophil gelatinase-associated lipocalin is an early predictor of acute kidney injury in premature infants[J]. Exp Ther Med, 2016, 12(6):3706-3710.
[39] Tabel Y, Elmas A, Ipek S, et al. Urinary neutrophil gelatinase-associated lipocalin as an early biomarker for prediction of acute kidney injury in preterm infants[J]. Am J Perinatol, 2014, 31(2):167-174.
[40] Fadel FI, Abdel Rahman AM, Mohamed MF, et al. Plasma neutrophil gelatinase-associated lipocalin as an early biomarker for prediction of acute kidney injury after cardio-pulmonary bypass in pediatric cardiac surgery[J]. Arch Med Sci, 2012, 8(2):250-255.
[41] Pejovi? B, Eri?-Marinkovi? J, Pejovi? M, et al. Detection of acute kidney injury in premature asphyxiated neonates by serum neutrophil gelatinase-associated lipocalin (sNGAL)-sensitivity and specificity of a potential new biomarker[J]. Biochem Med (Zagreb), 2015, 25(3):450-459.
[42] Han WK, Waikar SS, Johnson A, et al. Urinary biomarkers in the early diagnosis of acute kidney injury[J]. Kidney Int, 2008, 73(7):863-869.
[43] Harshman LA, Muffluett M, Neuberger ML, et al. Peritoneal dialysis in an extremely low-birth-weight infant with acute kidney injury[J]. Clin Kidney J, 2014, 7(6):582-585.
国家自然科学基金（81571480）；四川省科技厅科研项目资金（2014NZ0014）；泸州市科技局（泸州市政府-泸州医学院联合专项资金）（2013LZLY-J08）。
