Neonatal Kidney Size and Function in Preterm Infants: What Is a True Estimate of Glomerular Filtration Rate?

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• 作者：Carolyn L. Abitbol ; MD¹ ; ^{cabitbol@med.miaim.edu" class="auth_mail} ; Wacharee Seeherunvong ; MD¹ ; Marta G. Galarza ; MD² ; Chryso Katsoufis ; MD¹ ; Denise Francoeur ; RN¹ ; Marissa DeFreitas ; MD¹ ; Alcia Edwards-Richards ; MD¹ ; Vimal Master Sankar Raj ; MD¹ ; Jayanthi Chandar ; MD¹ ; Shahnaz Duara ; MD² ; Salih Yasin ; MD³ ; Gaston Zilleruelo ; MD¹
• 关键词：AKI ; Acute kidney injury ; Cr ; Creatinine ; CysC ; Cystatin C ; eGFR ; Estimated glomerular filtration rate ; GA ; Gestational age ; GFR ; Glomerular filtration rate ; iGFR ; Inulin glomerular filtration rate ; MAP ; Mean arterial pressure ; SES ; Socioeconomic status ; TKV ; Total kidney volume
• 刊名：The Journal of Pediatrics
• 出版年：May, 2014
• 年：2014
• 卷：164
• 期：5
• 页码：1026-1031.e2
• 全文大小：685 K

文摘

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Objectives

To distinguish between cystatin C (CysC) and creatinine (Cr) as markers of estimated glomerular filtration rate (eGFR) in preterm infants and to correlate eGFR with total kidney volume (TKV) as a surrogate of nephron mass.

Study design

Sixty preterm (<37聽weeks' gestational age [GA]) and 40 term infants were enrolled at birth. Serum Cr and CysC levels were assessed during the first week of life. Renal ultrasounds were performed to assess kidney dimensions with calculation of the TKV as a surrogate of nephron mass. Six equations derived from reference inulin, iohexol, and iothalamate clearance studies were used to calculate eGFR. Multiple regression analysis was applied to assess the relative impact of neonatal measures on eGFR, including TKV, GA, and mean arterial pressure (MAP).

Results

Renal lengths correlated with GA and were within the reference values for intrauterine measurements. Estimation equations for glomerular filtration rate (GFR) based on Cr, CysC, and combined CysC聽+聽Cr demonstrated that Cr-based equations consistently underestimated GFR, whereas CysC and combined equations were more consistent with referenced inulin clearance studies. Term infants demonstrated significantly better eGFR than preterm infants. TKV, GA, and MAP correlated positively with eGFR, although only MAP and GA remained significant when adjusted for other covariates.

Conclusions

Primary determinants of eGFR in preterm infants are GA and MAP. The CysC level is a superior biomarker to serum Cr in the assessment of GFR in premature infants.