Acute renal failure in the newborn: incidence and outcome.

OBJECTIVE

To describe an experience from a developing country of newborn renal disease particularly those without advanced neonatal care.

METHODOLOGY: Prospective evaluation from a referral hospital, North-East of Nigeria between 1 July 1990 and 30 June 1994. Babies admitted for any morbidities who were diagnosed as being in acute renal failure (ARF) during the study period (non-oliguric inclusive). Onset of ARF; day on which oliguria or anuria detected, or serum urea first exceeded 10 mmol/L. Urine output quantitated from carefully bagged urine and suprapubic bladder aspiration, and venous blood regularly obtained for serum electrolytes, urea and creatinine. Fractional excretion of sodium (FE(Na)) and renal failure index (RFI) were determined on some babies.

RESULTS

Forty-three neonates (M:F; 3.3:1) with ARF, the majority (27) of whom were out-born, and 14, 26 and three were preterm, full-term and post term, respectively. Encountered incidence was 3.9/1000 live births with a high prevalence rate; 34.5/1000 admissions. A significantly greater incidence was seen in the latter half of study; 10.7 vs 53.7/1000, P < 0.05. Early ARF occurrence (aged; 0-5 days) in 33 (77%) of babies. The aetiology was comprised of perinatal asphyxia, sepsis, obstructive uropathy and miscellaneous in 53.4%, 32.6%, 9.3% and 4.7%, respectively. Twenty-two (51.2%) deaths occurred; however, the exact causes were indeterminable. Fractional excretion of sodium (FE(Na)) and renal failure index (RFI) were of < 1.75% and < or = 2.0, respectively, significantly differentiated sepsis (intrinsic) from perinatal asphyxial (pre-renal) ARF; P < 0.01. No case of persistent renal failure occurred.

CONCLUSION

Our FE(Na) value (although less than reported in previous literature from affluent societies) remained sensitive (along with RFI) in differentiating aetiological group of ARF. Our data and medical management outcome, despite absence of level-III care, support the need for good resuscitation, careful monitoring and constant re-evaluation. The effect of salbutamol on hyperkalaemia is emphasized.