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Renal function of children receiving long-term parenteral nutrition
A A Moukarzel1, M E Ament, A Buchman
1Department of Pediatrics, University of California, Los Angeles.
Insights
Long-term total parenteral nutrition in children is linked to reduced kidney function, specifically a decreased glomerular filtration rate. The longer the duration of nutrition support, the lower the kidney filtration.
Area of Science:
- Pediatric Nephrology
- Clinical Nutrition
- Renal Physiology
Background:
- Total parenteral nutrition (TPN) is a life-sustaining treatment for children with intestinal failure.
- Long-term effects of TPN on pediatric renal function are not fully understood.
- Assessing renal function in children receiving long-term TPN is crucial for monitoring potential adverse effects.
Purpose of the Study:
- To evaluate renal function in children receiving long-term total parenteral nutrition.
- To identify potential correlations between TPN duration and renal function parameters.
- To investigate the association between TPN and glomerular filtration rate (GFR) in pediatric patients.
Main Methods:
- Assessed renal function in 13 children with a mean age of 9 years receiving TPN for a mean of 7.9 years.
- Measured glomerular filtration rate (GFR) using indium-111 labeled diethylenetriaminepentaacetic acid (DTPA) plasma clearance.
- Evaluated tubular function via beta-2-microglobulinuria and renal architecture/size using ultrasonography.
Main Results:
- All children exhibited a decreased GFR (mean 65.5 ml/min/1.73 m2), despite normal blood pressure, urinary sediment, and serum creatinine.
- Creatinine clearance was also reduced (mean 69.1 ml/min/1.73 m2).
- No tubular damage or nephrocalcinosis was detected; however, six children had reduced kidney size. Duration of TPN was inversely correlated with GFR (r = -0.66, p < 0.01).
Conclusions:
- Long-term total parenteral nutrition in children is associated with a significant decrease in glomerular filtration rate.
- The reduction in GFR appears related to the duration of TPN, not underlying disease or specific nephrotoxic drugs.
- Further research is needed to elucidate the exact mechanism behind TPN-induced renal function decline in pediatric patients.
Abstract:
Renal function was assessed in 13 children at a mean (+/- SD) age of 9 +/- 4.9 years who had been receiving total parenteral nutrition for 7.9 +/- 4.1 years. All children had normal blood pressure, urinary sediment, and serum creatinine concentrations (58.3 +/- 1.0 mumol/L). Glomerular filtration rate was measured by plasma clearance of diethylenetriaminepentaacetic acid labeled with indium 111. All 13 children had decreased glomerular filtration rate (65.5 +/- 11.9 ml/min per 1.73 m2; range 49.5 to 83.7). Creatinine clearance was 69.1 +/- 10.9 ml/min per 1.73 m2. No tubular damage, as assessed by beta 2-microglobulinuria, was detectable. Renal ultrasonography showed normal architecture with no evidence of nephrocalcinosis in all subjects. The kidney size was normal in seven children; six had reduced (less than -1 SD) size. No relationship was seen between the true glomerular filtration rate and diagnosis, number of episodes of infections, or antibiotics used. The duration of total parenteral nutrition was inversely correlated with the true glomerular filtration rate (r = -0.66, p less than 0.01). The decrease in glomerular filtration rate was not related to the underlying disease or to the nephrotoxic drugs used; the mechanism was not identified. We conclude that long-term total parenteral nutrition is associated with a decrease in glomerular filtration rate.