Cystic dysplasia of the kidneys in extremely preterm infants following acute kidney injury
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BRIEF REPORT
Cystic dysplasia of the kidneys in extremely preterm infants following acute kidney injury Seh Hyun Kim 1 & Yo Han Ahn 1,2 Chang Won Choi 1,3
&
Jeongmin Shin 1
&
Young Hwa Jung 1
&
Ji Young Kim 4
&
Received: 31 March 2020 / Revised: 19 July 2020 / Accepted: 31 July 2020 # IPNA 2020
Abstract Background Various perinatal morbidities may adversely affect postnatal nephrogenesis in preterm infants. Kidney ultrasonographic findings following acute kidney injury (AKI) have not been well described in preterm infants. Herein, we describe three cases of extremely preterm infants who showed abnormal kidney ultrasonographic findings resembling dysplasia of the kidneys following AKI. Case-diagnosis/treatment Their median gestational age and birth weight were 25+6 (range 23+3–26+6) weeks and 620 (480– 840) g, respectively. All infants suffered severe AKI during their third to seventh week of life. Their kidney function recovered with conventional management. Kidney ultrasonographies performed after AKI revealed increased kidney echogenicity, loss of corticomedullary differentiation, and multiple cortical cysts, which were similar to cystic dysplasia of the kidneys and were absent in previous kidney imaging. Three infants eventually developed at least one of the long-term kidney sequelae following AKI, including proteinuria, hypertension, and elevated levels of serum creatinine or cystatin C as determined during the last follow-up at the corrected age of 9–18 months. Conclusions Based on these cases, we can infer that AKI occurring during the early postnatal period may result in dysplasia of the kidneys with cortical cysts in extremely preterm infants, which may lead to chronic kidney disease in their later life. It is useful to follow up not only laboratory parameters but also kidney ultrasonographic findings in extremely preterm infants who suffered AKI during their early postnatal periods. Keywords Acute kidney injury . Extremely premature infant . Chronic kidney disease . Kidney cyst
Introduction Chronic changes in kidney ultrasonography (USG) findings following acute kidney injury (AKI) have not been well described in preterm infants. The incidence of AKI has been
* Yo Han Ahn [email protected] 1
Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
2
Department of Pediatrics, Seoul National University Children’s Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
3
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
4
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
reported to be 25–40% in preterm infants [1–3]. The more premature they are, the more vulnerable they are to kidney insults. The incidence of AKI has been reported to be 48% in preterm infants born before 29 weeks of gestation and 18% in preterm infants born at 29- to 35-week gestation [1]. A long-term follow-up study reported high rates of chronic kidney disease (CKD) in survivor
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