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Acute kidney injury (AKI) is common in critically ill premature infants. They are more susceptible to renal injury than older infants and children because of the functional and developmental immaturity of neonatal kidney. There is no unifi ed defi nition for neonatal AKI. AKI in neonates is often multifactorial and may result from prenatal, perinatal, or postnatal insults as well. Serum creatinine (SCr) concentration at birth is similar to the mother’s value. We present a case of prematurely born twins who were admitted to the paediatric intensive care unit because of AKI. Laboratory examination showed equally elevated levels of blood urea nitrogen (BUN) and SCr and metabolic alkalosis in both twins. High values of BUN and SCr were the result of the mother’s unrecognized renal disease. On the seventh postnatal day, SCr and BUN in twins were within the normal ranges. In all cases with high SCr levels in neonates in the fi rst 72 hours after birth, it is mandatory to check the mother’s renal function.

Premature twins with acute renal injury it is not always what it seems to be