Assessment of kidney function in preterm infants: lifelong implications
| Autor: | Carolyn Abitbol, Marissa DeFreitas, Jose Strauss |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Nephrology medicine.medical_specialty Population 030232 urology & nephrology Urology Physiology Renal function Kidney Volume 030204 cardiovascular system & hematology Kidney Function Tests 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Pregnancy Internal medicine medicine Humans education Creatinine education.field_of_study biology urogenital system business.industry Infant Newborn Infant Gestational age chemistry Cystatin C Renal physiology Pediatrics Perinatology and Child Health biology.protein Female Kidney Diseases business Infant Premature |
| Zdroj: | Pediatric Nephrology. 31:2213-2222 |
| ISSN: | 1432-198X 0931-041X |
| DOI: | 10.1007/s00467-016-3320-x |
| Popis: | This educational review will highlight the historical and contemporary references that establish a basic understanding of measurements of kidney function in the neonate and its relevance for the life of an individual. Importantly, the differential renal function of preterm infants relative to term infants has become paramount with the increased viability of preterm infants and the realization that kidney function is associated with gestational age. Moreover, neonatal kidney function is primarily associated with absolute renal mass and hemodynamic stability. Neonatal kidney function and its early developmental progression predict lifelong cardiovascular and renal disease risks. Validation of estimation equations of kidney function in this population has provided important reference data for other investigations and a clinical basis for prospective and longitudinal follow-up. Future research should be directed towards a better understanding of surrogate markers of kidney function from infancy through adulthood. Pediatric nephrologists should be aware of the developmental aspects of kidney function including the importance of the congenital nephron endowment and the preservation of kidney function throughout a lifetime. • Nephrogenesis occurs in utero in concert with other organ systems by branching morphogenesis, including the lungs, pancreas, and vascular tree, with over 60 % of nephrons being formed during the last trimester. • Infants born preterm before 36 weeks' gestation are in active nephrogenesis and are at increased risk of having a decreased nephron endowment from prenatal and postnatal genetic and epigenetic hazards that will impact the patient for a lifetime. • Post-natal adaptation of kidney function is directly proportional to the number of perfused nephrons, estimated by total kidney volume (TKV), mean arterial pressure (MAP), and gestational age. • Accurate measurement of glomerular filtration rate (GFR) in infants is problematic due to the unavailability of the gold standard inulin. The traditional use of creatinine to estimate GFR is unreliable in preterm infants due to its tubular reabsorption by immature kidneys and its dependence on muscle mass as an endogenous marker. Alternative endogenous markers to estimate GFR are cystatin C and beta trace protein (BTP). • Long-term follow-up of renal function in those born preterm should be life long and should include assessment of GFR, total kidney volume (TKV) relative to body surface area (BSA), and cardiovascular risks including hypertension and vascular stiffness. |
| Databáze: | OpenAIRE |
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