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A Prospective Study ot Neonatal Acute Renal Failure: The Significance of Various Diagnostic Indices.

Journal of the Korean Pediatric Society 1987;30(4):378-384.
Published online April 30, 1987.
A Prospective Study ot Neonatal Acute Renal Failure: The Significance of Various Diagnostic Indices.
Kyung Hyo Kim, Seung Joo Lee, Keun Lee
Department of Pediatrics, College of Medicine, Ewha Womans University
신생아기의 급성 신부전과 각종 진단 기준의 평가
김경호, 이승주, 이 근
이화여자대학교 의과대학 소아과학교실
Abstract
Acute renal failure is defined as a sudden decrease in renal function resulting in progressive retention of nitrogenous waste products. Acute renal failure should be suspected in any infant who has a sustained decrease in urine output to less than 1 ml per kg per hour, a blood urea nitrogen level above 20 mg per dl, a serum creatinine level greater than 1.0 mg per dl or who fails to void within 48 hours of birth. Reduced renal perfusion in asphyxiated infant may result from several factors including hypoxia, hypotension, and acidosis. Prerenal acute renal failure is rapidly reversible early in the course of disease, if renal perfusion will ensue. Between December 1, 1984 and September 30, 1985, 78 inborn asphyxiated full term neonates were screened for evidence of oliguria and including 18 outbom oliguric neonates, we studied for the incidence of acute renal failure and diagnostic criteria that would separate prerenal from intrinsic renal failure. The results were as follows: 1) A diagnosis of presumptive acute renal failure was entertained in 18 of 78 (22.9%) inborn, asphyxiated neonates, but only 1 of 18 (5.6%) failed to respond to a rapid intravenous fluid challenge and was classified as having intrinsic renal failure. In 18 outbom oliguric neonates, 5 (27.9%) were classified as having intrinsic renal failure (p<0.05). 2) We evaluated diagnostic criteria that would separate prerenal from intrinsic renal failure and sharp demarcation of the two groups were possible only when the urine to serum ratios of creatinine, renal failure index or fractional excretion of sodium was used.
Key Words: Neonate, Asphyxia, Acute renal failure, Diagnostic indices


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