Проблема диагностики гипоксической нефропатии у недоношенных новорожденных и пути ее решения

Abstract

The study included 120 premature infants suffering from perinatal hypoxia, which have been divided into two groups by birth weight: group 1 – less than 1500 g, group 2 – more than 1500 g. Severity of renal disease was defined by creatinine and cystatin C levels in serum, interleukin-18 (IL-18) and lipocalin (NGAL) levels in urine on the 3rd-5th day of life, parameters of renal blood flow. The study found a significant increase (3 times) of serum creatinine in children of the test groups (p < 0.05) compared to the controls. The serum levels of cystatin C on the 3rd-5th day of life were 2.6 ± 0.21 ng/ ml (group 1) and 1.9 ± 0.12 ng/ml (group 2) that is significantly higher than in the controls (p < 0.01). The content of NGAL in newborns suffering from hypoxic nephropathy was 2.5-3 times higher than in the controls (p < 0.01). IL-18 levels were significantly higher too (p < 0.01). Renal blood flow investigation showed a significant decrease of systolic flow velocity in the trunk of the renal arteries and of pulsatility index (PI) among newborns affected. The study established clinical and laboratory features of hypoxic nephropathy in premature infants – edema and proteinuria of various severity, early significant increase in serum cystatin C, as well as lipocalin and IL-18 in urine, a significant reduction of the maximal systolic flow velocity in the trunk of the renal arteries and PI (p < 0.05) - that were more evident among the children with weight < 1500 g.