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Author: search.filters.author.Olivera JordanovaSubject: search.filters.subject.acute kidney injury

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    INCIDENCE, RISK FACTORS AND OUTCOMES OF ACUTE KIDNEY INJURY IN PRETERM NEWBORNS
    (Macedonian Association of Anatomists, 2021)
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    Elizabeta Shuperliska
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    Acute kidney injury is a sudden loss of renal function that results indeterioration ofthe renal’s ability to excrete urine in sufficient quantity and adequate composition. The aim of the study was to determine the incidence, risk factors and outcomes of acute kidney injury in pretermnewborns.The study was conducted at theUniversity Clinic of Pediatrics–Skopje.It was a clinical, epidemiological prospective study. In the period of two years, 40preterm newbornshospitalized at the Intensive Care Unit (ICU)with documentedkidney injury were analyzed. Medical data records of hospitalized preterm infants with kidney injury were processed. The material was statistically analyzed using methods of descriptive statistics. We evaluated 40 preterm newbornswith documented acute kidney injury,who at the period of 2 years were treated in the ICU. The prevalence of kidney injury was 6.9%. Most of the involved preterm newbornswere male(72%),and born at 32 to 37 weeks with low birth weight (58%). Prerenal injury was evaluated in 79.5% of the cases.The mortality rate was 36% and it was significantly higher in the group of preterm infants born under 28 weeks,with Extremely Low Birth Weight Newborns ELBW. (P=0.01). Acute kidney injury is a life threatening condition with a still high mortality rate. Appropriate treatment of kidney injury in newbornswith ELBW improves the outcomes and reduces the mortality of the disease.
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    ACUTE KIDNEY INJURY IN NEONATES AND NEUTOPHILIC GELATINOUS ASSOCIATED LIPOCALIN AS EARLY BIOMARKER
    (Macedonian Association of Anatomists, 2019)
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    Olivera Jordanova
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    Objective: Acute kidney injury (AKI) is a serious problem in neonates in intensive care units. It is defined as a rapid decrease in glomerular filtration that leads to retention of creatinine and nitrogenous waste products and usually with a decrease in urine output. NGAL represents the most promising biomarker for early detection of kidney injury. It can detect the kidney injury in the first 2 to 3 hours of its occurrence, even before there is a decrease in urine output and an increase in sCr. The aim of the study was to determine the role of biomarker NGAL in early detection of kidney injury in neonates. Methods. The study evaluated the neonates suffering kidney injury who at the period of three years were treated at the University Children's Hospital in Skopje. All cases of neonates with kidney injury were analyzed according to gender, gestational age, birth weight and risk factors such as asphyxia, sepsis, prematurity, meconium plug syndrome and congenital heart diseases. NGAL was analyzed in urine samples collected on two occasions (day of admission and 2 days later) and the concentration of NGAL was determined using NGAL ELISA KIT (Bioporto). Medical data records of admitted neonates with AKI were analyzed. The material was statistically processed using methods of descriptive statistics. Results. The study was carried out at the neonatal intensive care unit at the University Children's Hospital Skopje in which neonates with documented acute kidney injury were evaluated. The whole study has been performed during the 3 year period. The estimated prevalence of AKI in neonates was 6.4%. Most of the involved neonates in the study were born at term (68%) with predominance of male neonates (64%). The analyzed results showed a higher values of urinary NGAL on the day of admission (373.8 ± 194.9) and a slight upward trend, with further increase in the third day after admission (439.4 ± 254, 7). There was a significant difference between the uNGAL values and sCr values on the day of admission of neonates in NICU, p<0,001. The mean urinary NGAL values in neonates with AKI with lethal outcome were 586.39 ± 182.3 while the mean values in neonates without lethal outcome was 254.22 ± 28.5. This difference was statistically significant (p<0,001). Conclusion: Early, biomarker based identification of neonates at risk of kidney injury is a fundamental step toward AKI prevention. NGAL has ability to predict AKI before clinical signs are evident and can facilitate implementation of appropriate preventive measures and improve resource utilization. Its use allows us to make the right clinical decisions at the right time, before the illness is clinically manifest and take appropriate measures to prevent renal function decline.
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    Using Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE II) In Neonates with Acute Kidney Injury
    (ID Design 2012/Scientific Foundation SPIROSKI, 2019)
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    Olivera Jordanova
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    Background: Acute kidney injury is a severe clinical condition. It is common in neonates in intensive care unit. It is defined as a sudden deterioration in kidney function resulting in derangements in fluid balance, electrolytes, and waste products. The score for neonatal acute physiology perinatal extension in critically sick neonates with kidney injury is a useful tool for assessing the severity of the disease. Aim: This study aimed to determine the incidence of AKI and the role of SNAPPE 2 score in predicting mortality and morbidity of kidney injury in neonates. Methods: The study was designed as a prospective clinical investigation performed in the period of three years, which included 100 neonates (50 with AKI and 50 without AKI) hospitalised in intensive care unit of University Clinic of Children Diseases in Skopje. The severity of the illness of hospitalised newborn infants was estimated with SNAPPE 2 score realised in the first 12 hours of admission to NICU. Medical data records of admitted neonates with AKI were analysed. The material was statistically processed using methods of descriptive statistics. Results: During the study period, 770 new born's were hospitalised in the intensive care unit due to various pathological conditions and 50 new born's were selected with AKI. The control group consisted of 50 neonates with comparable associated pathological conditions, but without kidney injury. The calculated prevalence of AKI in neonates was 6.4%. Most of the involved neonates in the study in both groups (AKI and non-AKI) were born at term (64% and 54%) with a predominance of male neonates (68% and 60%). The mortality rate was significantly higher in newborns with AKI than in the control group (36% vs 24%) (p < 0.01). The mean SNAPPE 2 score value in neonates with AKI was higher than in the control group (58.72 vs 40.0), and the difference was significant (p = 0.00001). Difficult score level predominated in half (50%) of newborn infants with AKI, while median score level predominated in control group (42%). There was a significant difference between the mean score value in neonates with AKI and lethal outcome compared to neonates with AKI without lethal outcome (70.73 ± 18.6 vs 40.2 ± 16.6) (p < 0.0001). Conclusion: Acute kidney injury is a life-threatening condition with still high mortality rate. The severity of the illness of hospitalised neonates in an intensive care unit is estimated by SNAPPE 2 score. Also, the risk of mortality is estimated too, taking into consideration the fact that higher values of the score are associated with higher mortality. Appropriate treatment of neonates with severe kidney injury improves the outcome and reduces the mortality of the disease.