Introduction
Review
Epigenetic effects
Renal development and prematurity
Molecular mechanisms of nephron endowment
Aspects of renal impairment in preterm children
Glomerular function
Tubulopathy of prematurity
Maturation of renal function in the preterm
Risks of secondary renal impairment in the preterm infant
Assessment of renal injury
Serum creatinine (μmol/l) rise by | Serum creatinine rise × reference value* | Urinary output (ml/kg/h) | |
---|---|---|---|
0 | < 26.5 | < 1.5 | ≥0.5 |
1 | ≥26.5 (48 h) | ≥1.5–1.9 (7 days) | <0.5 × 6–12 h |
2 | ≥2–2.9 | <0.5 x > 12 h | |
3 | ≥221 or dialysis | ≥3 | <0.3 x ≥ 24 h or anuria x ≥12 h |
Hyponatremia, acidosis, and neonatal growth
Long-term renal consequences
Conclusions for neonatal care
During NICU | Health Maintenance for survivors of prematurity | |
---|---|---|
Monitoring renal function | Volume status, weight, ins and out Vital signs Serum electrolytes, crea, and FeNa: Supplementation if prudentMaintain target serum electrolyte values | Awareness of prematurity-related increased risk throughout lifespan [7] Assess serially volume status, weight, diuresis Vital signs (esp BP) Tubular parameters (FeNa/β2-M) Glomerular parameters (albumin/creatinine) |
Medications | Drug levels/pharmacist input=> Dosing adjustment Taking renal maturation into account Daily evaluation of medications | Awareness of baseline renal function appropriate choice and adjustment of potential medications |
Arterial hypertension | Blood pressure monitoring daily as needed in the acute/sick phase or if abnormal Rule out coarctation aortae Consider renal vascular Doppler | Blood pressure measurement With every health maintenance visit Target age-appropriate values [74] Counseling about salt sensitivity |
Nephrocalcinosis | Renal ultrasound before discharge | Follow-up ultrasound for resolution If progression consider urine Ca/creatinine |