Incidence of Acute Renal Failure (ARF) in Birth Asphyxia and its Correlation with Hypoxic Ischemic Encephalopathy (HIE) Staging

Abstract

Introduction: Acute kidney injury (AKI) previously known as Acute renal failure is a recognized complication of neonates with perinatal asphyxia. In all asphyxiated neonates emphasis must be laid on early recognition of AKF, so that it paves a way for timely and appropriately management thereby preventing consequences of irreversible renal failure. Aim: To determine the incidence of Acute renal failure in birth asphyxia and to correlate the severity of renal failure with and HIE grading of asphyxiated neonates. Materials and Methods: A case control study was conducted for a period of 1 year, where 100 term (37-42 wks) neonates born with Apgar score of 7/<7 at 5 minutes after birth were selected as cases and 50 normal term (37-42 wks) neonates as controls. Sarnat and Sarnat staging was used for HIE. After 72 hrs and before 96 hrs of life blood was collected and sent for relevant investigations and clinical condition of the baby and urine output was monitored and data was collected in predesigned proforma after informed consent. Results: Incidence of ARF is significantly more in cases (75.0% vs. 4.0%) 18.4 times more likely when compared to controls. Among the 75 cases which had acute renal failure , 64 (85.3%) had pre-renal ARF and 11(14.6%) had intrinsic ARF , and based on urine output 24 (32.0%) had oliguric ARF and 51 (68.0%) had non oliguric ARF and among the 50 controls 2 neonates had pre-renal and non-oliguric type of ARF. Incidence of ARF had a strong correlation with HIE staging. Conclusion: ARF in birth asphyxia is predominantly pre-renal ARF and responds to fluid challenge and it is of non oliguric type. ARF in birth asphyxia correlates well with HIE staging. Mortality is more in intrinsic ARF. Early diagnosis and management of renal failure helps in prevention of intrinsic renal failure and its consequences.

Keywords

• hypoxia
• kidneys
• neonates
• oliguria