You are on page 1of 7

Paediatrica Indonesiana

VOLUME 53 July  NUMBER 4

Original Article

Acute kidney injury in asphyxiated neonates


Roy Amardiyanto, Partini Pudjiastuti Trihono, Lily Rundjan, Hardiono D. Pusponegoro

W
Abstract RUOG+HDOWK2UJDQL]DWLRQGHILQHVDVSK\[LD
Background $VSK\[LD QHRQDWRUXP PD\ UHVXOW LQ PXOWLRUJDQ as failure to breath spontaneous and
dysfunction including renal involvement. There is no consensus regularly at birth.  The incidence of
RQWKHGHWHUPLQDWLRQRIDFXWHNLGQH\LQMXU\ $., LQQHRQDWHV DVSK\[LDLQYDULRXVFRXQWULHVUDQJHVIURPWR
making establishment of the diagnosis and its management
EHFRPHV GLIILFXOW 7KH $FXWH .LGQH\ ,QMXU\ 1HWZRUN $.,1 
of live birth. ,Q ,QGRQHVLD HVWLPDWHG LQFLGHQFH
UHFRPPHQGV$.,FULWHULDEDVHGRQLQFUHDVHGVHUXPFUHDWLQLQH RIQHRQDWDODVSK\[LDLVRIOLYHELUWK4 A study
level and reduced urine output. performed at the Department of Child Health,
Objectives 7R LGHQWLI\ WKH SUHYDOHQFH RI $., LQ DVSK\[LDWHG 8QLYHUVLW\ RI ,QGRQHVLD 0HGLFDO 6FKRRO&LSWR
QHRQDWHVXVLQJWKH$.,1FULWHULDWRFRPSDUHWKHGLIIHUHQFHRI 0DQJXQNXVXPR +RVSLWDO 56&0  LQ  UHSRUWV
$.,VWDJHVDQGWKHJORPHUXODUILOWUDWLRQUDWHV *)5 EHWZHHQ
PRGHUDWHDQGVHYHUHDVSK\[LD
 QHRQDWDO DVSK\[LD RI DOO ELUWK5 +\SR[LD DQG
Methods 7KLVZDVDFURVVVHFWLRQDODQDO\WLFDOVWXG\FRQGXFWHG DFXWHLVFKHPLDGXHWRDVSK\[LDFDXVHPXOWLRUJDQG\V
EHWZHHQ-XO\DQG-DQXDU\6XEMHFWVZHUHDOODVSK\[LDWHG function including renal dysfunction which reached
QHRQDWHV $SJDUVFRUHDWILIWKPLQXWH ZLWKJHVWDWLRQDODJHRI FDVHV7KHRFFXUUHQFHRI$.,LQQHRQDWHVZLWK
>35 weeks delivered and hospitalized in Cipto Mangunkusumo $SJDUVFRUHRQILUVWPLQXWHLVDQGLQDERXW
+RVSLWDO DQG .RMD 'LVWULFW +RVSLWDO -DNDUWD ,QGRQHVLD
Glomerular filtration rate was calculated using the components
RIWKHPWKHNLGQH\LQMXU\FRQWLQXHVXQWLO
RI XULQH FUHDWLQLQH VHUXP FUHDWLQLQH DQG XULQH RXWSXW ZKLOH hours after birth. Until now, no universal definition
$.,VWDJHVZHUHGHWHUPLQHGDFFRUGLQJWR$.,1FULWHULD8ULQDU\ H[LVWVDERXW$.,0RVWVWXGLHVXVHGVHUXPFUHDWLQLQH
output was measured via urethral catheterization. OHYHO RI !PJG/ DV D FXWRII SRLQW RI $., LQ
Results2IVXEMHFWVWKHUHZHUHQHRQDWHVZLWKPRGHUDWH neonates. $FXWH .LGQH\ ,QMXU\ 1HWZRUN $.,1 
DQGQHRQDWHVZLWKVHYHUHDVSK\[LDZLWKWKHSUHYDOHQFHRI$.,
ZDV7ZHQW\RQHRXWRIQHRQDWHVZLWKVHYHUHDVSK\[LD
UHFRPPHQGVFULWHULDRI$.,EDVHGRQWKHLQFUHDVHRI
H[SHULHQFHG$.,ZKLOHQHRQDWHVZLWKPRGHUDWHDVSK\[LDZKR VHUXPFUHDWLQLQHOHYHODQGRUGHFUHDVHRIXULQHRXWSXW
H[SHULHQFHG$.,ZDVRXWRIVXEMHFWV  7ZRWKLUGRI DQGFODVVLILHV$.,LQWRWKUHHVWDJHVVWDJH PLOG 
QHRQDWHVZLWKVHYHUHDVSK\[LDZKRH[SHULHQFHG$.,KDGVWDJH (moderate), and 3 (severe).
RI$.,0RUHVHYHUH$.,VWDJHVDQGORZHUPHGLDQ*)5ZHUH
We aimed to LGHQWLI\WKHSUHYDOHQFHRI$.,RQ
IRXQGLQQHRQDWHVZLWKVHYHUHFRPSDUHGWRPRGHUDWHDVSK\[LD
3  QHRQDWDODVSK\[LDXVLQJ$.,1FULWHULDWRUHFRJQL]H
Conclusion7KHSUHYDOHQFHRI$.,LQQHRQDWDODVSK\[LDLVKLJK
 7KHPRUHVHYHUHGHJUHHRIQHRQDWDODVSK\[LDWKHPRUH
VHYHUH$.,VWDJHDQGWKHORZHUPHGLDQ*)5[Paediatr Indones.
2013;53:232-8.]. )URPWKH'HSDUWPHQWRI&KLOG+HDOWK8QLYHUVLW\RI,QGRQHVLD0HGLFDO
6FKRRO&LSWR0DQJXQNXVXPR+RVSLWDO-DNDUWD,QGRQHVLD

Keywords: acute kidney injury, asphyxiated neonates, Reprint request to: Roy Amardiyanto, Department of Child Health,
serum creatinine, urine output 8QLYHUVLW\ RI ,QGRQHVLD 0HGLFDO 6FKRRO &LSWR 0DQJXQNXVXPR
+RVSLWDO -O 'LSRQHJRUR  -DNDUWD 7HO  (PDLO
UR\DPDUGL\DQWR#JPDLOFRm

232Paediatr Indones, Vol. 53, No. 4, July 2013


Roy Amardiyanto et al: $FXWHNLGQH\LQMXU\LQDVSK\[LDWHGQHRQDWHV

IRUWKHUHODWLRQVKLSRI$.,VWDJHVZLWKWKHVHYHULW\ characteristics of the neonates and mothers were


RIDVSK\[LDDQGWRLGHQWLI\WKHJORPHUXODUILOWUDWLRQ recorded, anthropometries data were measured, and
rate (GFR) in neonates with moderate and severe the estimation of gestational age was performed by
DVSK\[LD using Ballard chart. The history of pregnancy and
delivery, the diagnosis of hospitalization, and data of
resuscitation in the delivery or operating room were
Methods recorded. Mothers serum creatinine level before
delivery was also recorded, but if the data was not
$FURVVVHFWLRQDODQDO\WLFDOVWXG\ZDVSHUIRUPHGLQ available, then mothers serum creatinine level was
the Neonatology Division of Cipto Mangunkusumo PHDVXUHGLQKRXUVDIWHUKDYLQJELUWK
Hospital (RSCM) and District Hospital (RSUD) Koja An urethral catheter was performed in neonates
-DNDUWDIURP-XOLWR-DQXDUL6XEMHFWVZHUH to measure the time of first micturition, then the
all neonates with gestational age >35 weeks with TXDQWLW\ RI XULQH ZDV FROOHFWHG E\ QXUVHV XQWLO 
$SJDUVFRUHRQWKHILIWKPLQXWHZKRZHUHERUQDQG KRXUVRIDJH All neonates were using diapers, so
KRVSLWDOL]HGLQ56&0DQG568'.RMD:HH[FOXGHG that if there was a leak from the catheter, the diapers
neonates with major congenital malformation on ZHUHZHLJKWHGZLWKDJUDPVHQVLWLYLW\VFDOH The
SK\VLFDOH[DPLQDWLRQDWELUWKRUGHWHFWHGSUHYLRXVO\ VXEMHFWZDVH[FOXGHGIURPWKLVVWXG\LIXULQHTXDQWLW\
E\ XOWUDVRXQG RQ SUHQDWDO H[DPLQDWLRQ QHRQDWHV ZDVQRWPHDVXUHGLQPRUHWKDQKRXUV:KHQWKH
with syndromes, neonates who received vancomycin, QHRQDWHVDJHGKRXUVDPOEORRGVDPSOHZDV
IXURVHPLGH LQGRPHWKDFLQ RU LEXSURIHQ DV ZHOO DV taken to measure serum creatinine level and urine
QHRQDWHV GLHG EHIRUH  KRXUV RU SDUHQWV GLG QRW ZDVFROOHFWHGIRUKRXUVWRPHDVXUHXULQHFUHDWLQLQH
give any consent to follow the study. Subjects were Blood and urine samples were taken simultaneously.
WDNHQ FRQVHFXWLYHO\ $ VDPSOH RI  QHRQDWHV ZDV The measurement of serum and urine creatinine
needed based on single sample formula to estimate level was performed by using Enzymatic Creatinine_2
a proportion of a population. A minimal subjects of ADVIA 1800 machine with enzymatic method.
HDFKQHRQDWHVIRUHDFKVWDJHRIDVSK\[LD PRGHUDWH Glomerular filtration rate (GFR) was calculated based
and severe) was needed, based on formula two on estimated creatinine clearance H&&O RQ
independent group proportions. hours age using the following formula::

eCCl = UCr x urine (mL/menit) x 1.73 mL/minute/1.73 m2 BSA


SCr BSA

Apgar score estimation was performed on $FXWHNLGQH\LQMXU\LVGHILQHGDVVHUXPFUHDWL


PLQXWH st, 5th DQG th by pediatricians, residents QLQH OHYHO LQFUHDVHG E\ RU PRUH WKDQ  PJG/
RUE\QXUVHVPLGZLYHVEDVHGRQUHOLDELOLW\WHVWZLWKD measured by the difference between mothers and
.DSSDVFRUH0RGHUDWHDVSK\[LDZDVGHILQHGDV QHRQDWHVVHUXPFUHDWLQLQHOHYHOVDWKRXUVRU
WKH$SJDUVFRUHRIWRRQWKHILIWKPLQXWHZKLOH the increase of percentage neonates serum creatinine
VHYHUH DVSK\[LD ZDV WKH $SJDU VFRUH RI  RQ WKH OHYHOVDWKRXUVE\FRPSDUHGWRPRWKHUV
fifth minute. The parents were informed about the serum creatinine levels, or a decrease in urine output
study and were asked for the consent. The baseline P/NJKRXUPRUHWKDQKRXUVDIWHUILUVWXULQH

Table 1#-+0ETKVGTKC9
Stage Serum creatinine Urine output
1 Increase >0.3 mg/dL or <0.5 mL/kg/hour over 6 hours
increase >150-200% baseline
2 Increase >200-300% baseline <0.5 mL/kg/hour over 12 hours
3 Increase >300% baseline or <0.3 mL/kg/hour over 24 hours
> 4.0mg/dL with acute increase or no urine for 12 hours
> 0.5mg/dL

Paediatr Indones, Vol. 53, No. 4, July 2013233


Roy Amardiyanto et al: $FXWHNLGQH\LQMXU\LQDVSK\[LDWHGQHRQDWHV

7KH $., ZDV GHWHUPLQHG EDVHG RQ $.,1 FULWHULD Table 2. Characteristics of subjects
DQG$.,VWDJHZDVFKRVHQEDVHGRQWKHZRUVWVWDJH Characteristics n=94
of serum creatinine level increase or urine output Mean birth weight (SD), gram 2.737 (581)
Median birth length (range), cm 48 (41-53)
decrease (Table 1).
Sex, n (%)
0RWKHUVVHUXPFUHDWLQLQHOHYHOSHUIRUPHGEHIR
Male 57 (61)
UHGHOLYHU\RUKRXUVDIWHUGHOLYHU\FRQVLGHUHGDVWKH Female 37 (39)
baseline serum creatinine level of the neonates. The Median gestational age (range), weeks 38 (35-43)
QRUPDO FXWRII SRLQW IRU PRWKHUV VHUXP FUHDWLQLQH Degree of asphyxia, n (%)
OHYHO ZDV  PJG/ 7KH PHDQ QRUPDO *)5 RQ Moderate 70 (75)
QHRQDWHV ZLWK JHVWDWLRQDO DJH  ZHHNV DW DJH  Severe 24 (25)
Delivery type, n (%)
DQGGD\VZHUH 6' DQG 6' P/
Spontaneous 40 (43)
PLQP, consecutively. Vacuum extraction 8 (9)
This study had approval from Ethical Committee Forceps extraction 1 (1)
RI8QLYHUVLW\RI,QGRQHVLD0HGLFDO6FKRRO$OOSDUHQWV Caesarian surgery 46 (47)
gave consents for the study. /GFKCPTUVOKEVWTKVKQPCIG
TCPIG JQWTU 7 (1-36)
7KHGLIIHUHQFHEHWZHHQPRGHUDWHDQGVHYHUH$.,
ZHUH DQDO\]HG E\ XVLQJ &KLVTXDUH RU .ROPRJRURY but 3 neonates were of incomplete data, therefore
6PLUQRYZKHUH&KLVTXDUHZDVQRWDEOHWREHDSSOLHG WKH\H[SHOOHGIURPWKHDQDO\VLV7KHUHZHUHDWRWDO
0DQQ:KLWQH\WHVWZDVXVHGIRUDQDO\]LQJQXPHULFDO RI  DVSK\[LDWHG QHRQDWHV UHFUXLWHG LQ WKLV VWXG\
GDWD7KHVLJQLILFDQFHLQWKLVVWXG\ZDV3 FRQVLVWHG RI  QHRQDWHV ZLWK PRGHUDWH DVSK\[LD
DQGQHRQDWHVZLWKVHYHUHDVSK\[LD%LUWKZHLJKW
ELUWKOHQJWKVH[JHVWDWLRQDODJHGHJUHHRIDVSK\[LD
Results type of delivery, and age of first micturition are listed
on Table 2. Mean and median of mothers serum
'XULQJWKHVWXG\SHULRGWKHUHZHUHOLYHELUWK FUHDWLQLQH OHYHO ZHUH  6'   PJG/ DQG 
ZLWK  QHRQDWHV IXOILOOHG WKH LQFOXVLRQ FULWHULD UDQJH PJG/UHVSHFWLYHO\

Table 3. Prevalences and stages of acute kidney injury in all asphyxiated neonates
Variables Numbers
n=94
$CUGFQP#-+0ETKVGTKCP

#-+ 59 (63)
5VCIGUQH#-+
Stage 3 18 (31)
Stage 2 18 (31)
Stage 1 23 (38)
0Q#-+ 35 (37)
Based on serum creatinine level, n (%)
#-+ 44 (47)
5VCIGUQH#-+
Stage 3 9 (21)
Stage 2 12 (27)
Stage 1 23 (52)
0Q#-+ 50 (53)
$CUGFQPJQWTUWTKPGQWVRWVEQNNGEVGFCHVGTTUVOKEVWTKVKQPP

#-+ 39 (42)
5VCIGUQH#-+
Stage 3 13 (33)
Stage 2 15 (39)
Stage 1 11 (28)
0Q#-+ 55 (58)

234Paediatr Indones, Vol. 53, No. 4, July 2013


Roy Amardiyanto et al: $FXWHNLGQH\LQMXU\LQDVSK\[LDWHGQHRQDWHV

7KHGHWHUPLQDWLRQRI$.,VWDJHVEDVHGRQ$.,1 GHFUHDVHRIKRXUVXULQHRXWSXWFROOHFWHGDIWHUILUVW
criteria was assessed based on the increase of serum micturition are shown in Table 4.
FUHDWLQLQH OHYHO DQGRU GHFUHDVH RI  KRXUV XULQH Table 5 shows that neonates with severe
output collected after first micturition. Based on those DVSK\[LD KDG D KLJKHU PHGLDQ UDQJH  RI VHUXP
WZRLQGLFDWRUVWKHSUHYDOHQFHRI$.,ZDVVXEMHFWV creatinine level and a lower median (range) of GFR
 7KHUHZHUH  QHRQDWHVZLWK$.,VWDJH FRPSDUHG WR WKH PRGHUDWH DVSK\[LD 3 
 1HRQDWHV ZLWK $., EDVHG RQ LQFUHDVH RI VHUXP 3UHVSHFWLYHO\ 
FUHDWLQLQHOHYHORQO\ZHUH  WKLVZDVFRPSULVH
RI  QHRQDWHVZLWKVWDJH$.,7KHQHRQDWHV
ZLWK$.,EDVHGRQGHFUHDVHRIKRXUVXULQHRXWSXW Discussion
DIWHUILUVWPLFWXULWLRQZDV  DPRQJVWWKHP
 QHRQDWHVKDGVWDJHRI$., Table 3). The numbers of neonates with moderate and severe
7KHFRPSDULVRQRISUHYDOHQFHDQGVWDJHRI$., DVSK\[LDZHUH  DQG  FRQVHFXWLYHO\
LQ PRGHUDWH DQG VHYHUH DVSK\[LD EDVHG RQ $.,1 7KLVLVDOPRVWVLPLODUZLWKRWKHUVWXGLHVZKLFKUHSRU
criteria, increase of serum creatinine level, and WHGWKHQXPEHUVRIPRGHUDWHDQGVHYHUHDVSK\[LDZHUH

Table 42TGXCNGPEGUCPFUVCIGUQH#-+DCUGFQPUGXGTKV[QHCURJ[ZKC
Variables Severe asphyxia group Moderate asphyxia group P value
(n=24) (n=70)
$CUGFQP#-+0ETKVGTKCP

Yes 21 38 0.003#
No 3 32
Stages
Stage 3 14 4 <0.001#
Stage 2 5 14
Stage 1 2 22
Based on serum creatinine increasing level, n (%)
Yes 16 28 0.025#
No 8 42
Stages
Stage 3 6 3 0.458*
Stage 2 4 8
Stage 1 6 17
$CUGFQPWTKPGQWVRWVJQWTUCHVGTTUVOKEVWTKVKQPP

Yes 20 19 <0.001#
No 4 51
Stages
Stage 3 12 1 <0.001#
Stage 2 6 9
Stage 1 2 9
%JK5SWCTGVGUV -QNOQIQTQX5OKTPQXVGUV

Table 55GTWOETGCVKPKPGNGXGNUCPFINQOGTWNCTNVTCVKQPTCVGUQPOQFGTCVGCPFUGXGTGCURJ[ZKC
P
48-72 hours
Moderate asphyxia (n=74) Severe asphyxia (n=24) P value
Median (range) Median (range)
Serum creatinine level (mg/dL) 0.62 (0.42-1.88) 0.84 (0.40-3.32) 0.005*
GFR based on eCCl (mL/min/1.73m2) 29.59 (9.46-115.53) 11.21 (2.11-43.8) <0.001*
* Mann-Whitney test

Paediatr Indones, Vol. 53, No. 4, July 2013235


Roy Amardiyanto et al: $FXWHNLGQH\LQMXU\LQDVSK\[LDWHGQHRQDWHV

  DQG   Almost all neonates with serum creatinine level compared to this study.
DVSK\[LDKDGILUVWPLFWXULWLRQLQKRXUVDIWHUELUWK ,QWKLVVWXG\QHRQDWHV  KDG$.,EDVHG
7KHUHZDVQHRQDWHZLWKVHYHUHDVSK\[LDKDGLWVILUVW RQDGHFUHDVHRIKRXUVXULQHRXWSXWFROOHFWHGDIWHU
PLFWXULWLRQDWKRXUV0DQRHet al reported 3 out of first micturition. Perlman et alUHSRUWHGWKDWRXWRI
QHRQDWHVZLWKDVSK\[LDKDGWKHLUILUVWPLFWXULWLRQ QHRQDWHVZLWKDVSK\[LDKDGROLJXULD Mohan et al
LQKRXUVDIWHUELUWK,QQHRQDWHVZLWKDVSK\[LD UHSRUWHGWKDWRXWRIQHRQDWHVZLWKDVSK\[LDKDG
DSDUDO\VLVRIEODGGHUPLJKWWHPSRUDULO\H[LVWZKLFK oliguria. Vasoconstriction of afferent arterioles which
may cause urine tardiness. The low prevalence of RFFXUUHDWWKHWLPHRIK\SR[HPLDOHDGVWRDGHFUHDVH
QHRQDWHV ZLWK DVSK\[LD ZLWK ILUVW PLFWXULWLRQ ! in urine output due to a decrease of blood flow to the
hours in this study might be because of the use of kidneys. Perlmans report was similar to this study,
urinary catheter which ensure urine output, although probably because of relatively similar subject criteria
there might be temporary bladder paralysis. although they added the parameters of pH and pCO
,QWKLVVWXG\  QHRQDWHVZLWKDVSK\[LDKDG RIXPELOLFDOFRUGDUWHU\LQGLDJQRVLQJDVSK\[LDThe
$.,EDVHGRQLQFUHDVHRIVHUXPFUHDWLQLQHOHYHODQGRU high incidence of oliguria in Mohans report might be
decrease of urine output. The result is similar to a report because of kidney injury occurred more severe than
from Aggarwal et al and Karlowicz et al who reported those in our study. Mohan used tighter criteria for
DQGQHRQDWHVZLWKDVSK\[LDKDGDFXWHUHQDO QHRQDWDODVSK\[LDWKRVHZHUHORZHU$SJDUVFRUHDQG
failure, consecutively. Askenazi et alUHSRUWHG WKH RFFXUUHQFH RI K\SR[LF LVFKHPLF HQFHSKDORSDWK\
QHRQDWHVZLWKDVSK\[LDKDG$.,DQG6HOHZHVNLet al +,( +\SR[LFLVFKHPLFHQFHSKDORSDWK\LQGLFDWHV
UHSRUWHGQHRQDWHVZLWKDVSK\[LDZKRZHUHWUHDWHG WKH VHYHULW\ RI K\SR[LD LQ WKH ERG\ ZKLFK LQGXFHV
ZLWKK\SRWKHUPLFPHWKRGKDG$.,DFFRUGLQJWR$.,1 organs, including kidney, to have worse disruptions
FULWHULD7KHKLJKSUHYDOHQFHRI$.,LQWKLVVWXG\PLJKW FRPSDUHGWRDVSK\[LDZLWKRXW+,(
EHGXHWRVHYHUHDQGORQJK\SR[LDDQGK\SRSHUIXVLRQ 7KHSUHYDOHQFHRI$.,LQPRGHUDWHDQGVHYHUH
of the kidney. This in turn caused a disturbance in the DVSK\[LDEDVHGRQWKHLQFUHDVHRIVHUXPFUHDWLQLQH
nephrons which will increase the serum creatinine level OHYHODQGRUWKHGHFUHDVHRIXULQHRXWSXWZDV  
DQGGHFUHDVHRIXULQHRXWSXW7KHORZLQFLGHQFHRI$., DQG  FRQVHFXWLYHO\7KHGLIIHUHQFHRI$.,
in the study by Askenazi et al might be due to subject SUHYDOHQFH EHWZHHQ PRGHUDWH DQG VHYHUH DVSK\[LD
analysis was only performed on neonates with moderate ZDV  5DGLW\R et al reported the difference of
DVSK\[LDZKLOHWKHORZLQFLGHQFHRI$.,LQWKHVWXG\RI SUHYDOHQFH RI  +LJK SUHYDOHQFH RI $., LQ
Seleweski et al might be due to the effect of hypothermic VHYHUH DVSK\[LD SUREDEO\ GXH WR WKH K\SR[LD DQG
WKHUDS\LQWKHNLGQH\VRIQHRQDWHVZLWKDVSK\[LD hypoperfusion conditions of the kidney are more
7KH SUHYDOHQFH RI $., EDVHG RQ LQFUHDVH RI severe and longer standing compared to moderate
VHUXP FUHDWLQLQH OHYHO RQO\ ZDV    0DQRH DVSK\[LD0RUHQHSKURQGLVUXSWLRQVLQVHYHUHDVSK\[LD
et alUHSRUWHGWKDWRXWRI  QHRQDWHVZLWK lead to more increase of serum creatinine level and
ILIWKPLQXWH$SJDUVFRUHKDGDQLQFUHDVHRIVHUXP GHFUHDVH RI XULQH RXWSXW WKDQ PRGHUDWH DVSK\[LD
creatinine level. The assault of the nephrons due to 7KH ILQGLQJV WKDW PRUH $., ZDV IRXQG LQ VHYHUH
K\SR[LD RU K\SRSHUIXVLRQ ZLOO OHDG WR D GHFUHDVH LQ DVSK\[LDWHGQHRQDWHVFRPSDUHGWRPRGHUDWHDVSK\[LD
creatinine clearance which in turn will increase serum are similar to other previous studies.
creatinine level. 7KH SUREOHP RI GLDJQRVLV RI $., This study also indicates that neonates with
based on serum creatinine level only in neonates is that VHYHUHDVSK\[LDDUHPRUHOLNHO\WRKDYHPRUHVHYHUH
neonates serum creatinine level is still influenced by $., VWDJHV FRPSDUHG WR PRGHUDWH DVSK\[LD 7KLV
the creatinine level of the mother. The serum creatinine PLJKW EH GXH WR VHYHUH K\SR[LD RQ QHRQDWHV ZLWK
level was still similar to mothers.,QWKLVVWXG\WKH VHYHUH DVSK\[LD ZKLFK OHDGV WR GLVUXSWLRQ RI EORRG
increase of serum creatinine level was measured by IORZWRNLGQH\FRPSDUHGWRPRGHUDWHDVSK\[LD
FRPSDULQJQHRQDWHVVHUXPFUHDWLQLQHOHYHODW 7KHPHGLDQRIVHUXPFUHDWLQLQHOHYHORQQHRQD
hours with mothers serum creatinine level. The low WHVZLWKVHYHUHDVSK\[LDZDVKLJKHUWKDQPRGHUDWH
SUHYDOHQFHRI$.,LQWKHVWXG\E\0DQRHet al might DVSK\[LD7KLVUHVXOWLVVLPLODUZLWKRWKHUVWXGLHV
be due to the difference of measurement of neonates This might happen due to more nephron disruptions

236Paediatr Indones, Vol. 53, No. 4, July 2013


Roy Amardiyanto et al: $FXWHNLGQH\LQMXU\LQDVSK\[LDWHGQHRQDWHV

LQVHYHUHDVSK\[LDWKDQPRGHUDWHDVSK\[LD 
7KHPHGLDQ*)5RQVHYHUHDVSK\[LDZDVORZHU  &KULVWRSKHU3%DUQHWW0D[33DXO*(&OLQLFRSDWKRORJLFDO
WKDQ PRGHUDWH DVSK\[LD 7ZR PHDQV FRPSDULVRQ FRUUHODWLRQLQSRVWDVSK\[LDORUJDQGDPDJHDGRQRURUJDQ
analysis for the difference of GFR in severe and SHUVSHFWLYH3HGLDWULFV
PRGHUDWHDVSK\[LDUHYHDOVDVLJQLILFDQWGLIIHUHQFH:H  /HH$&&0XOODQ\/&7LHOVK-0.DW]-.KDWU\6./H&OHUT
FDQFRQFOXGHWKDWWKHPRUHVHYHUHWKHDVSK\[LDWKH SC, et al. Risk factors for neonatal mortality due to birth
lower the value of GFR. Umboh reports that there DVSK\[LDLQ6RXWKHUQ1HSDODSURVSHFWLYHFRPPXQLW\EDVHG
ZDVDVLJQLILFDQWGLIIHUHQFHRI*)5LQPLOGPRGHUDWH FRKRUWVWXG\3HGLDWULFV
DVSK\[LDFRPSDUHGWRVHYHUHDVSK\[LD7KHPHGLDQ*)5 4. Alisjahbana A, Hidayat S, Mintardaningsih, Primardi A,
IRUPRGHUDWHDQGVHYHUHDVSK\[LDUHSRUWHGLQWKDWVWXG\ Herliani E, Sofiatin Y, et al.0DQDJHPHQWRIELUWKDVSK\[LD
ZDV 6' DQG 6' P/PLQP, DWKRPHDQGKHDOWKFHQWHU3DHGLDWU,QGRQHV
consecutively. We found a larger difference between 
PHGLDQ *)5 RI QHRQDWHV ZLWK VHYHUH DVSK\[LD DQG  'DWD 'LYLVL 1HRQDWRORJL 'HSDUWHPHQ ,.$ ).8,56&0
PRGHUDWHDVSK\[LDFRPSDUHGWR8PERKVVWXG\7KLV 
might be because the difference of diagnostic criteria of  6KDK 3 5LSKDJHQ 6 %H\HQH - 3HUOPDQ 0 0XOWLRUJDQ
DVSK\[LDXVHG$VSK\[LDWHGQHRQDWHVLQ8PERKVVWXG\ G\VIXQFWLRQLQLQIDQWVZLWKSRVWDVSK\[LDOK\SR[LFLVFKHPLF
ZDVGHILQHGDV$SJDUVFRUHDWWKHILUVWPLQXWHZKLOH HQFHSKDORSDWK\$UF'LV&KLOG)HWDO1HRQDWDO
LQRXUVWXG\ZHGHILQHGDVSK\[LDDVWKH$SJDUVFRUH 5.
DWWKHILIWKPLQXWH/RQJVWDQGLQJDQGVHYHUHK\SR[LDLQ  .DXU6-DLQ66DKD$&KDZOD'3DUPDU95%DVX6et
this study compared to Umbohs probably has an effect al. Evaluation of glomerular and tubular renal function in
WRWKHORZHU*)5LQVHYHUHDVSK\[LD QHRQDWHVZLWKELUWKDVSK\[LD$QQ7URS3DHGLDWU
Limitations of this study were the criteria for 34.
DVSK\[LDEDVHGRQO\RQ$SJDUVFRUHRQILIWKPLQXWH  $JJDUZDO$.XPDU3&KRZGDU\*0DMXPGDU61DUDQJ
RI  WKH QHRQDWHV VHUXP FUHDWLQLQH OHYHO ZDV $(YDOXDWLRQRIUHQDOIXQFWLRQVLQDVSK\[LDWHGQHZERUQV-
H[DPLQHG RQFH DW  KRXUV DQG WKH HWLRORJ\ RI 7URS3HGLDWU
$., ZDV QRW H[SORUHG IXUWKHU %XW WKLV VWXG\ DOVR  0HKWD 5/ .HOOXP -$ 6KDK 69 0ROLWRULV %$ 5RQFR &
has superiority, where urinary output was monitored Warnock DG, et al. Acute kidney injury network: Report of
carefully using urinary catheter therefore we could an initiative to improve outcome in acute kidney injury. Crit
JHWH[DFWDPRXQWRIXULQHDQGWKHVHUXPFUHDWLQLQH &DUH
level was performed using an enzymatic method thus  *XSWD%'6KDUPD3%DJOD-3DUDNK06RQL-35HQDOIDLOXUH
hemolysis, icteric serum, and albumin level did not LQDVSK\[LDWHGQHRQDWHV,QGLDQ3HGLDWU
disturb the result.  0DQRH 90 .HODLQDQ QHIURORJLN SDGD DVILNVLD QHRQDWRUXP
:H FRQFOXGH WKDW $., SUHYDOHQFH EDVHG RI GL 5XPDK 6DNLW 'U &LSWR 0DQJXQNXVXPR >WHVLV@
$.,1FULWHULDVRQQHRQDWDODVSK\[LDLVWKHPRUH -DNDUWD8QLYHUVLWDV,QGRQHVLD
VHYHUHWKHDVSK\[LDWKHPRUHSUHYDOHQFHDQGVHYHULW\  $PLQXOODK $ $VILNVLD ED\L EDUX ODKLU ,Q 0DUNXP $+
RIWKH$.,VWDJHV7KHPHGLDQRI*)5EDVHGRQH&&O ,VPDHO6$ODWDV+$NLE$)LUPDQV\DK$6DVWURDVPRUR6
LQ QHRQDWHV ZLWK PRGHUDWH DVSK\[LD LV KLJKHU WKDQ editor. Buku ajar ilmu kesehatan anak. Jakarta: Balai Penerbit
WKHVHYHUHDVSK\[LD&RQVLGHULQJ$.,SUHYDOHQFHLV ).8,S
KLJKLQQHRQDWHVZLWKDVSK\[LDDQGORZ*)5LQVHYHUH  .DUORZLF]0*$GHOPDQ5'1RQROLJXULFDQGROLJXULFDFXWH
DVSK\[LDPHGLFDOSURIHVVLRQDOVQHHGWRDOHUWRQWKH UHQDOIDLOXUHLQDVSK\[LDWHGWHUPQHRQDWHV3HGLDWU1HSKURO
SRVVLELOLW\ RI $., LQ QHRQDWDO DVSK\[LD WKHUHIRUH 
prompt interventions can be made.  $VNHQD]L'-.RUDONDU5+XQGOH\+(0RQWHVDQWL$3DWLO1
Ambalavanan N. Fluid overload and mortality are associated
ZLWK DFXWH NLGQH\ LQMXU\ LQ VLFN QHDUWHUPWHUP QHRQDWH
References 3HGLDWU1HSKURO
 6HOHZHVNL'7-RUGDQ%.$VNHQD]L'-'HFKHUW5(6DUNDU
 :RUOG +HDOWK 2UJDQL]DWLRQ %DVLF QHZERUQ UHVXFLWDWLRQ 6$FXWHNLGQH\LQMXU\LQDVSK\[LDWHGQHZERUQVWUHDWHGZLWK
a practical guide. Geneva: World Health Organization. WKHUDSHXWLFK\SRWKHUPLD-3HGLDWU

Paediatr Indones, Vol. 53, No. 4, July 2013237


Roy Amardiyanto et al: $FXWHNLGQH\LQMXU\LQDVSK\[LDWHGQHRQDWHV

 $ODWDV + $QDWRPL GDQ ILVLRORJL JLQMDO ,Q $ODWDV + 
Tambunan T, Trihono PP, Pardede SO, editor. Buku ajar  .RVQDGL/1HIURORJLQHRQDWDO,Q$ODWDV+7DPEXQDQ7
QHIURORJL DQDN (GLVL NH -DNDUWD %DODL 3HQHUELW ).8, Trihono PP, Pardede SO, editors. Buku ajar nefrologi anak.
S (GLVLNH-DNDUWD%DODL3HQHUELW).8,S
 *XLJQDUG-3'UXNNHU$:K\GRQHZERUQLQIDQWVKDYHD  5DGLW\R$1.RVLP060XU\DZDQ+$VILNVLDQHRQDWRUXP
KLJKSODVPDFUHDWLQLQH"3HGLDWULFV sebagai faktor risiko gagal ginjal akut. Sari Pediatri.
 3HUOPDQ -0 5HQDO LQMXU\ LQ WKH DVSK\[LDWHG QHZERUQ 
infant: relationship to neurologic outcome. J Pediatr.  8PERK$+XEXQJDQDVILNVLDQHRQDWRUXPGHQJDQJDQJJXDQ
 IXQJVLJLQMDOSDGDED\LEDUXODKLU6DUL3HGLDWUL
 0RKDQ393DL305HQDOLQVXOWLQDVSK\[LDQHRQDWRUXP 3.
,QGLDQ3HGLDWU  .RUQKDXVHU & 'XEH\ /$ *DUD\ 0( 3HUH]/XTXH (/
 -HUQLN$*&HUQDGDV-0&*RUHQVWHLQ$5DPLUH]-$9DLQ 0DODFDUD-09DUJDV2ULJHO$6HUXPDQGXULQDU\LQVXOLQH
1$UDQGRPL]HGGRXEOHEOLQGSODFHERFRQWUROOHGWULDORI OLNHJURZWKIDFWRUDQGWXPRUQHFURVLVIDFWRULQQHRQDWHV
the effect of prophylactic theophylline on renal function with or without acute renal failure. Pediatr Nephrol.
LQ WHUP QHRQDWHV ZLWK SHULQDWDO DVSK\[LD 3HGLDWULFV 

238Paediatr Indones, Vol. 53, No. 4, July 2013