Neonatal Acute Kidney Injury-An Australian and New Zealand Perspective

Area of Science:

• Neonatology
• Nephrology
• Pediatric Critical Care

Background:

• Neonatal acute kidney injury (AKI) is a significant, underdiagnosed condition with severe short- and long-term consequences.
• Neonatal physiology presents unique vulnerabilities, including immature renal function and ongoing kidney development.
• Advances in consensus definitions, like the neonatal Kidney Disease Improving Global Outcomes (KDIGO) criteria, have improved understanding but gaps remain.

Purpose of the Study:

• To synthesize current evidence on neonatal AKI, covering physiology, definitions, epidemiology, and management.
• To highlight the need for improved surveillance, diagnosis, and follow-up protocols for neonatal AKI.
• To emphasize opportunities for collaborative improvement in kidney care for infants in Australia, New Zealand, and globally.

Main Methods:

• This narrative review synthesizes existing literature on neonatal renal physiology and AKI.
• It examines evolving consensus definitions and biomarkers for AKI diagnosis.
• The review discusses epidemiological data, management strategies, and policy implications.

Main Results:

• Neonatal AKI has profound implications for survival, kidney function, and cardiovascular health.
• Despite improved definitions, variability in AKI surveillance and diagnosis persists globally.
• Research highlights the need for integrated metrics and equitable kidney care for infants.

Conclusions:

• Protocolized monitoring, preventative strategies (e.g., nephrotoxin stewardship), and long-term follow-up are crucial for AKI survivors.
• Addressing AKI requires enhanced education, protocol development, and inter-regional collaboration.
• Improving neonatal kidney care is essential to mitigate progression to chronic kidney disease.