Neonatal acute kidney injury: Reassessing diagnostic criteria for acute kidney injury in neonates with hypoxic-ischaemic encephalopathy undergoing therapeutic hypothermia.

Kristinsdóttir Þ, Chromek M, Blennow M, Robertsson Grossmann K.

research-articleOpen access

AI summary — for doctors, generated from the abstract only

Adding the Gupta definition (insufficient creatinine decline) to nKDIGO identified extra neonates with AKI after hypothermia-treated HIE and was linked to higher cystatin C at 10-12 years.

What was studied

Retrospective cohort of 55 near-term and term neonates with hypothermia-treated hypoxic-ischaemic encephalopathy in Stockholm (2007-2009), classified as nKDIGO-AKI, Gupta-AKI or no AKI, with follow-up for kidney function signs at 10-12 years.

Key findings

31 neonates (56%) had AKI: 17 (31%) met both definitions, 7 (13%) Gupta only and 7 (13%) nKDIGO only
Inotropic support was more common with AKI under either definition (p = 0.03 for each)
Gupta-AKI was associated with higher cystatin C at 10-12 years (p = 0.03)

Clinical relevance

Suggests creatinine-based nKDIGO may miss clinically meaningful neonatal AKI, so a creatinine-decline criterion may be worth adding.

Who should care

NephrologyPediatric Nephrology

Limitations

Only 55 infants from one setting, retrospective, with small subgroup sizes and no effect sizes or confidence intervals shown; long-term follow-up completeness is not described.

The Gupta definition captures extra at-risk neonates, but larger studies are needed to confirm its value.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Background

Acute kidney injury (AKI) remains common in neonates with hypothermia-treated hypoxic-ischaemic encephalopathy (HIE). Although the modified neonatal KDIGO (nKDIGO) criteria form the diagnostic standard, their reliance on serum creatinine (SCr) increase and urine output (UO) is particularly challenging in early onset neonatal AKI. The Gupta definition, based on insufficient SCr-decline, has been proposed to identify neonates with clinically significant AKI uncaptured by nKDIGO.

Methods

This retrospective cohort included 55 near-term/term neonates with hypothermia-treated HIE in Stockholm (2007-2009). Applying nKDIGO and Gupta criteria, infants were categorised as nKDIGO-AKI, Gupta-AKI, or no AKI. Primary outcome was AKI-incidence, secondary outcomes included mortality, organ support, length of stay, and signs of possible impaired kidney function at 10-12 years.

Results

In our cohort, 31 (56%) suffered AKI: 17 (31%) fulfilled both definitions, 7 (13%) Gupta-only, and 7 (13%) nKDIGO-only. Need for inotropic support was more common among infants with nKDIGO-AKI compared to those without nKDIGO-AKI (p = 0.03). In a subanalysis, a significantly larger proportion of infants with Gupta-AKI needed inotropic support compared to those without Gupta-AKI (p = 0.03). Gupta-AKI was associated with a significantly higher cystatin C at 10-12 years (p = 0.03) compared to those without Gupta-AKI.

Conclusions

The Gupta definition identified additional infants with AKI beyond nKDIGO. For both definitions, a larger proportion of infants needed inotropic support in the AKI-group compared to those without AKI. Children with a history of Gupta-AKI had a significantly higher cystatin C in early adolescence compared to those without. Incorporating Gupta criteria may improve identification of infants with significant AKI.

DOI

10.1007/s00467-026-07469-2

PMID

42484653

PMCID

PMC13672522

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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