Predictive Factors of Acute Renal Failure in the Neonates with Respiratory Distress Syndrome


1 1.Iran University of Medical Sciences, Tehran, Iran

2 Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran

3 Iran University of Medical Sciences, Tehran, Iran

4 Ali Asghar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran


Background: Preterm birth occurs in a large number of pregnancies, and its incidence has been reported to be on the rise. Acute kidney injury (AKI) is a common complication in the premature infants with respiratory distress syndrome (RDS). The present study aimed to determine the predictive factors, clinical courses, and outcomes of AKI in the neonates with the clinical and radiological manifestations of RDS.
Methods: Medical records of 84 premature neonates with RDS were evaluated in two groups of case (with AKI) (n=34) and control (without AKI) (n=50). Diagnosis of AKI was based on the increased level of serum creatinine (>1.5 mg/dL) after the third day of birth or increasing serum creatinine level. In addition, blood pressure and laboratory findings, including complete blood count, serum electrolytes, and urine volume, were compared between the two groups.
Results: Mean age of the infants with AKI was 5.41±3.29 days, and the majority of the patients had nonoliguric renal failure. Among the samples, 23.5% died, and 76.5% were discharged without renal impairment. Birth weight, systolic blood pressure, blood urea nitrogen, calcium, and pH on admission had significant correlations with the presence of AKI. Moreover, birth weight was observed to be a relatively accurate predictive factor for AKI (AUC=0.08; 95% CI=0.68-0.91), with 73.5% sensitivity and 80% specificity.
Conclusion: According to the results, AKI was more common in the low-birth-weight infants with severe RDS compared to the other subjects


1. Tabel Y, Oncül M, Elmas AT, Güngör S. Evaluation of renal functions in preterm infants with respiratory distress syndrome. J Clin Lab Anal. 2014; 28(4):310-4.
2. Elmas AT, Tabel Y, Elmas ON. Serum cystatin C predicts acute kidney injury in preterm neonates with respiratory distress syndrome. Pediatr Nephrol. 2013; 28(3):477-84.
3. El-Badawy AA, Makar S, Abdel-Razek AR, Abd Elaziz D. Incidence and risk factors of acute kidney injury among the critically ill neonates. Saudi J Kidney Dis Transpl. 2015; 26(3):549-55.
 4. Csaicsich D, Russo-Schlaff N, Messerschmidt A, Weninger M, Pollak A, Aufricht C. Renal failure, comorbidity and mortality in preterm infants. Wien Klin Wochenschr. 2008; 120(5-6):153-7.
 5. Andreoli SP. Acute renal failure in the newborn. Semin Perinatol. 2004; 28(2):112-23.
6. Wambach JA, Hamvas A. Respiratory distress syndrome in the neonates. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Diseases of the fetus and infants. 10th ed. Philadelphia: Elsevier Saundres; 2015. P. 1074-86.
 7. Bolat F, Comert S, Bolat G, Kucuk O, Can E, Bulbul A, et al. Acute kidney injury in a single neonatal intensive care unit in Turkey. World J Pediatr. 2013; 9(4):323-9.
8. Youssef D, Abd-Elrahman H, Shehab MM, AbdElrheem M. Incidence of acute kidney injury in the neonatal intensive care unit. Saudi J Kidney Dis Transpl. 2015; 26(1):67-72.
 9. Mathur NB, Agarwal HS, Maria A. Acute renal failure in neonatalsepsis. Indian J Pediatr. 2006; 73(6):499-502.
10. Viswanathan S, Manyam B, Azhibekov T, Mhanna MJ. Risk factors associated with acute kidney injury in extremely low birth weight (ELBW) infants. Pediatr Nephrol. 2012; 27(2):303-11.
11. Stojanović V, Barišić N, Milanović B, Doronjski A. Acute kidney injury in preterm infantsadmitted to a neonatal intensive care unit. Pediatr Nephrol. 2014; 29(11):2213-20.
12. Cataldi L, Leone R, Moretti U, De Mitri B, Fanos V, Ruggeri L, et al. Potentialrisk factors for the development of acute renal failure in pretermnewborn infants: a case-control study. Arch Dis Child Fetal Neonatal Ed. 2005; 90(6):F514-9.
 13. Hentschel R, Lödige B, Bulla M. Renal insufficiency in the neonatalperiod. Clin Nephrol. 1996; 46(1):54-8.
14. Lunn AJ, Shaheen I, Watson AR. Acute renal in sufficiency in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2006; 91(5):F38.
15. Vachvanichsanong P, McNeil E, Dissaneevate S, Dissaneewate P, Chanvitan P, Janjindamai W. Neonatal acute kidney injury in a tertiary center in a developing country. Nephrol Dial Transplant. 2012; 27(3):973-7.
 16. Nickavar A, Khosravi N, Mazouri A. Predictive factors for acute renal failure in neonates with septicemia. Arch Pediatr Infect Dis. 2017; 5(4):e61627.