The Indian Journal of Pediatrics

, Volume 81, Issue 3, pp 243–247 | Cite as

Evaluation of Renal Function in Term Babies with Perinatal Asphyxia

  • Jayom Karlo
  • B. Vishnu BhatEmail author
  • B. C. Koner
  • B. Adhisivam
Original Article



To study the renal function in term newborns with perinatal asphyxia including urinary excretion of β2 microglobulin (β2M).


This case control study included 50 term newborn babies with perinatal asphyxia and 50 normal babies as matched controls. In all cases, asphyxia grading (using Apgar score) and Hypoxic ischemic encephalopathy (HIE) staging (Sarnat and Sarnat) were done. Blood and urinary parameters (including β2M) for renal function were done in all and Fractional excretion of sodium (FENa) and Renal failure index (RFI) were calculated. The renal parameters were compared within subgroups as well as controls using analysis of variance test and the independent samples t test.


Acute kidney Injury (AKI) was noted in 56 % of cases (24 % prerenal and 32 % intrinsic type). All 9 babies who died had AKI. Serum parameters like urea, creatinine, sodium and potassium had better correlation with the renal function as compared to urine parameters. All individual urine parameters except β2M showed wide variations. FENa, RFI and urinary β2M increased with increasing severity of asphyxia and HIE staging.


AKI is common in term babies with perinatal asphyxia. FENa and RFI are useful parameters for assessing the renal function and urinary β2M is a good biomarker for diagnosis and prognosis of acute tubular injury in term babies with perinatal asphyxia.


Perinatal asphyxia Acute kidney injury Newborn Urinary β2 microglobulin Fractional excretion of sodium 



JK collected and analyzed data; BVB designed and supervised the study; BCK helped with the biochemical investigations and BA drafted manuscript.

Conflict of Interest


Role of Funding Source



  1. 1.
    Perlman JM, Tack ED, Martin T, Shackelford G, Amon E. Acute systemic organ injury in term infants after asphyxia. Am J Dis Child. 1989;143:617–20.PubMedGoogle Scholar
  2. 2.
    Durkan AM, Alexander RT. Acute kidney injury post neonatal asphyxia. J Pediatr. 2011;158:e29–33.PubMedCrossRefGoogle Scholar
  3. 3.
    el-Mauhoub M, Kishan J, Jaiswal OP, Asbali AA, el houni N. Urinary beta 2-microglobulin as an indicator of proximal renal tubular dysfunction in asphyxiated full-term newborns. Pediatr Nephrol. 1994;8:787.Google Scholar
  4. 4.
    Kaur S, Jain S, Saha A, Chawla D, Parmar VR, Basu S, et al. Evaluation of glomerular and tubular renal function in neonates with birth asphyxia. Ann Trop Paediatr. 2011;31:129–34.PubMedCrossRefGoogle Scholar
  5. 5.
    Jayashree G, Dutta AK, Sarna MS, Saili A. Acute renal failure in asphyxiated newborns. Indian Pediatr. 1991;28:19–23.PubMedGoogle Scholar
  6. 6.
    Misra PK, Kumar A, Natu SM, Kapoor RK, Srivastava KL, Das K. Renal failure in symptomatic perinatal asphyxia. Indian Pediatr. 1991;28:1147–51.PubMedGoogle Scholar
  7. 7.
    Ashraf M, Ahmed N, Chowdhary J, Saif RU. Acute renal failure: Nephrosonographic findings in asphyxiated neonates. Saudi J Kidney Dis Transpl. 2011;22:1187–92.Google Scholar
  8. 8.
    Mondal N, Bhat BV, Banupriya C, Koner BC. Oxidative stress in perinatal asphyxia in relation to outcome. Indian J Pediatr. 2010;77:515–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Espinel CH. The FENa test. Use in the differential diagnosis of acute renal failure. JAMA. 1976;236:579–81.PubMedCrossRefGoogle Scholar
  10. 10.
    McGuire W. Perinatal asphyxia. Clin Evid (Online) 2007;2007. pii: 0320.Google Scholar
  11. 11.
    Perlman JM, Tack ED. Renal injury in the asphyxiated newborn infant: Relationship to neurologic outcome. J Pediatr. 1988;113:875–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Nouri S, Mahdhaoui N, Beizig S, Zakhama R, Salem N, Ben Dhafer S, et al. Acute renal failure in full term neonates with perinatal asphyxia. Prospective study of 87 cases. Arch Pediatr. 2008;5:229–35.CrossRefGoogle Scholar
  13. 13.
    Agras PI, Tarcan A, Baskin E, Cengiz N, Gürakan B, Saatci U. Acute renal failure in the neonatal period. Ren Fail. 2004;26:305–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Aggarwal A, Kumar P, Chowdhary G, Majumdar S, Narang A. Evaluation of renal functions in asphyxiated newborns. J Trop Pediatr. 2005;51:295–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Gupta BD, Sharma P, Bagla J, Parakh M, Soni JP. Renal failure in asphyxiated neonates. Indian Pediatr. 2005;42:928–34.PubMedGoogle Scholar
  16. 16.
    Askenazi DJ, Ambalavanan N, Goldstein SL. Acute kidney injury in critically ill newborns: What do we know? What do we need to learn? Pediatr Nephrol. 2009;24:265–74.Google Scholar
  17. 17.
    Aldana VC, Romaro MS, Vargas OA, Hernández AJ. Acute complications in full term neonates with severe neonatal asphyxia. Ginecol Obstet Mex. 1995;63:123–7.Google Scholar
  18. 18.
    Goodwin TM, Belai I, Hernandez P, Durand M, Paul RH. Asphyxial complications in the term newborn with severe umbilical acidemia. Am J Obstet Gynecol. 1992;167:1506–12.PubMedCrossRefGoogle Scholar
  19. 19.
    Karlowicz MG, Adelman RD. Nonoliguric and oliguric acute renal failure in asphyxiated term neonates. Pediatr Nephrol. 1995;9:718–22.PubMedCrossRefGoogle Scholar
  20. 20.
    Mathew OP, Jones AS, James E, Bland H, Groshong T. Neonatal renal failure: Usefulness of diagnostic indices. Pediatrics. 1980;65:57–60.Google Scholar
  21. 21.
    Coca SG, Yalavarthy R, Concato J, Parikh CR. Biomarkers for the diagnosis and risk stratification of acute kidney injury: A systematic review. Kidney Int. 2008;73:1008–16.Google Scholar
  22. 22.
    Askenazi DJ, Koralkar R, Hundley HE, Montesanti A, Parwar P, Sonjara S, et al. Urine biomarkers predict acute kidney injury in newborns. J Pediatr. 2012;161:270–5.Google Scholar
  23. 23.
    Sarafidis K, Tsepkentzi E, Agakidou E, Diamanti E, Taparkou A, Soubasi V, et al. Serum and urine acute kidney injury biomarkers in asphyxiated neonates. Pediatr Nephrol. 2012;27:1575–82.PubMedCrossRefGoogle Scholar
  24. 24.
    Fernandez F, Barrio V, Guzman J, Huertas MD, Zapatero M, de Miguel MD, et al. Beta-2-microglobulin in the assessment of renal function in full term newborns following perinatal asphyxia. J Perinat Med. 1989;17:453–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Martin AA, Garcia AA, Gaya F, Cabanas F, Burgueros M, Quero J. Multiple organ involvement in perinatal asphyxia. J Pediatr. 1995;127:786–93.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2013

Authors and Affiliations

  • Jayom Karlo
    • 1
  • B. Vishnu Bhat
    • 1
    Email author
  • B. C. Koner
    • 2
  • B. Adhisivam
    • 1
  1. 1.Department of PediatricsJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PondicherryIndia
  2. 2.Department of BiochemistryJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PondicherryIndia

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