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BMC Nephrology

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Open Access 01-12-2022 | Acute Kidney Injury | Research

Long-term follow-up of patients after acute kidney injury in the neonatal period: abnormal ambulatory blood pressure findings

Authors: Gulsen Akkoc, Ali Duzova, Ayse Korkmaz, Berna Oguz, Sule Yigit, Murat Yurdakok

Published in: BMC Nephrology | Issue 1/2022

Abstract

Background

Data on the long-term effects of neonatal acute kidney injury (AKI) are limited.

Methods

We invited 302 children who had neonatal AKI and survived to hospital discharge; out of 95 patients who agreed to participate in the study, 23 cases were excluded due to primary kidney, cardiac, or metabolic diseases. KDIGO definition was used to define AKI. When a newborn had no previous serum creatinine, AKI was defined as serum creatinine above the mean plus two standard deviations (SD) (or above 97.5^th percentile) according to gestational age, weight, and postnatal age. Clinical and laboratory features in the neonatal AKI period were recorded for 72 cases; at long-term evaluation (2–12 years), kidney function tests with glomerular filtration rate (eGFR) by the Schwartz formula, microalbuminuria, office and 24-h ambulatory blood pressure monitoring (ABPM), and kidney ultrasonography were performed.

Results

Forty-two patients (58%) had stage I AKI during the neonatal period. Mean age at long-term evaluation was 6.8 ± 2.9 years (range: 2.3–12.0); mean eGFR was 152.3 ± 26.5 ml/min/1.73 m². Office hypertension (systolic and/or diastolic BP ≥ 95^th percentile), microalbuminuria (> 30 mg/g creatinine), and hyperfiltration (> 187 ml/min/1.73 m²) were present in 13.0%, 12.7%, and 9.7% of patients, respectively. ABPM was performed on 27 patients, 18.5% had hypertension, and 40.7% were non-dippers; 48.1% had abnormal findings. Female sex was associated with microalbuminuria; low birth weight (< 1,500 g) and low gestational age (< 32 weeks) were associated with hypertension by ABPM. Twenty-three patients (33.8%) had at least one sign of microalbuminuria, office hypertension, or hyperfiltration. Among 27 patients who had ABPM, 16 (59.3%) had at least one sign of microalbuminuria, abnormal ABPM (hypertension and/or non-dipping), or hyperfiltration.

Conclusion

Even children who experienced stage 1 and 2 neonatal AKI are at risk for subclinical kidney dysfunction. Non-dipping is seen in four out of 10 children. Long-term follow-up of these patients is necessary.

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Title: Long-term follow-up of patients after acute kidney injury in the neonatal period: abnormal ambulatory blood pressure findings
Authors: Gulsen Akkoc
Ali Duzova
Ayse Korkmaz
Berna Oguz
Sule Yigit
Murat Yurdakok
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Acute Kidney Injury
Microalbuminuria
Hypertension
Acute Kidney Injury
Hypertension
Published in: BMC Nephrology / Issue 1/2022
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-022-02735-5

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