Serum Creatinine Levels in First Week of Newborn Infant - Influence of Weight And Gestational Age: A Prospective Cohort Study
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 9
Abstract
Introduction Serum creatinine measurement is most widely used and commonly accepted index of renal function. It is an important and reliable indicator of renal health because its biological reference intervals are relatively constant during the life time of an adult individual without a superimposed renal failure.Daily Approximately 2% of muscle creatine is converted to creatinine. (1)(2) Glycine, arginine, and methionine participate in creatine biosynthesis.Glycine and arginine form guanidoacetate in kidney an intermediate in biosynthesis of creatinine. Creatine synthesis is completed by methylation of guanidoacetate by S- adenosyl methionine(3)(4).Creatine is converted to creatine phosphate by creatine kinase, a reversible reaction. Creatine by a non-enzymatic, irreversible, spontaneous reaction is converted to creatinine, which is anhydride of creatine .(4)(5) Kidneys remove creatinine from the blood primarily by glomerular filtration and proximal tubular secretion. Little or no tubular reabsorption of creatinine occurs. Renal function can be evaluated by measuring the GFR. As it is not easy to measure the GFR directly, the serum creatinine concentration is often used to assess renal function.(1) If the kidney filtration is deficient, creatinine blood levels rise. Therefore, creatinine levels in blood and urine may be used to calculate the creatinine clearance (CrCl), which correlates with the glomerular filtration rate (GFR). Blood creatinine levels may also be used alone to calculate the estimated GFR (eGFR).(6)(7) Serum creatinine (SeCr) concentration is the most commonly used glomerular filtration marker in adult persons. It is also used to asses glomerular filtration rate in neonates .(8) Glomerular filtration rate is low in fetal and neonatal life. It increases after birth and reaches approximately 20 mL/min/1.73 m2 at 1 month of age in term and preterm neonates. The methods used to measure glomerular filtration rate in neonates are inulin clearance, creatinine clearance, and serum cystatin C. Serum creatinine or calculated creatinine clearance are the most convenient estimates of GFR, requiring only a single blood sample and urine sample at same time. (1) (9) During the first few days of life, the serum creatinine reflects maternal renal function or the maternal creatinine. Serum creatinine is transported across the placenta in a bidirectional manner. Serum creatinine reflects maternal GFR for at least initial 72 hrs.(10)(8) The assessment of renal function is critical for the adjustment of medication dosing and in planning fluid, nutritional and electrolyte support. The measurement and interpretation of renal function in premature neonates is complicated by in utero events, maternal drug exposure , mode of delivery, gestational age, birth weight, postnatal illness severity, renal development and changing muscle mass.(11) The serum creatinine in preterm infants can initially increase before it declines to a steady state and does not necessarily represent acute kidney injury(12). Preterm birth is often associated with gestational diseases affecting placental function and/or maternal renal function. Furthermore, some gestational diseases may also affect fetal glomerular development by inducing intrauterine growth restriction.(13) However, data on how these values change over time and how they are influenced by gestational age and birth weight are limited. In the light of these facts, the purpose of this study was to evaluate serum creatinine levels in the 1st week of life in newborn infants, in relation to gestational age and birth weight
Authors and Affiliations
Dr. A. Yashowanth Rao, Dr. Narendra Babu Devabathina
Keywords
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- EP ID EP255981
- DOI 10.9790/0853-1609036883
- Views 54
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