An Interesting Case of Neonatal AKI: What Is the Time to Consider Anuria Irreversible?
Antonio Gatto,
Eloisa Tiberi,
Serena Ferretti,
Valerio Santoro,
Alessandra Piersanti,
Filomena Valentina Paradiso,
Lorenzo Nanni,
Roberto Iezzi,
Alessandro Posa,
Simonetta Costa,
Giovanni Vento
Affiliations
Antonio Gatto
Department of Pediatrics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
Eloisa Tiberi
Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
Serena Ferretti
Department of Pediatrics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
Valerio Santoro
Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Alessandra Piersanti
Neonatology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Filomena Valentina Paradiso
Pediatric Surgery Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
Lorenzo Nanni
Pediatric Surgery Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
Roberto Iezzi
Department of Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
Alessandro Posa
Department of Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
Simonetta Costa
Neonatology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Giovanni Vento
Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
Acute kidney injury is a frequent complication for critical newborns. Its management is a significant challenge, especially in extremely low-birth-weight (ELBW) infants. Currently, peritoneal dialysis (PD) is the most manageable treatment. However, data are lacking regarding when diuresis can be declared irreversible relative to the start of PD. A female infant born at 28 + 0 weeks with a birth weight of 800 g by monochorionic diamniotic pregnancy, complicated by twin-to-twin transfusion syndrome, developed acute renal failure on the second day of life because of long-term intrauterine hypoperfusion. PD was started on day 7. The patient remained anuric until the 52nd day of dialysis, when she presented adequate urine output of 2.5 mL/kg/h and PD was suspended for 11 days. After an episode of sepsis, PD was re-started, and after 50 days of treatment, given a urine output of 1.5 mL/kg/h, it was discontinued. The patient died on day 132 after a disseminate infection, which led to multiorgan failure. In ELBW infants, PD is a valid therapeutic instrument to treat patients with renal failure. Despite the evidence of low renal functional reserve in these patients, the duration of recovery from diuresis after a period of anuria can be very long.
