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Background
Measurement of neonatal renal function is challenging, and accurate, easy-to-use markers to estimate glomerular filtration rate (eGFR) are lacking. This study aimed to evaluate principal determinants of GFR in neonates and develop a predictive equation.
Methods
GFR was measured, using single injection inulin clearance, at median day 3 o...
Contexts in source publication
Context 1
... evaluated three existing equations estimating GFR in our population, the neonatal Schwartz, Zappitelli, and combined Zappitelli [18]. The specificities of these equations are shown in Table 1. Of note, Zappitelli equations were not designed to be used before the age of 12 months [22]. ...Context 2
... evaluated three existing equations estimating GFR in our population, the neonatal Schwartz, Zappitelli, and combined Zappitelli [18]. The specificities of these equations are shown in Table 1. Of note, Zappitelli equations were not designed to be used before the age of 12 months [22]. ...Similar publications
Gut microbiota manipulation may reverse metabolic abnormalities in obesity. Our previous studies demonstrated that inulin supplementation significantly promoted Bifidobacterium and fat-free mass in obese children. We aimed to study gut-muscle axis from inulin supplementation in these children. In clinical phase, the plasma samples from 46 participa...
Background: We aimed to determine the course of serum creatinine (sCr), serum cystatin C (sCysC) and urine cystatin C (uCysC) levels and calculate estimated glomerular filtration rate (eGFR) by using sCr- and sCysC-based formulas in preterm infants in the first 28 days of life.
Methods: A total of 52 neonates were included in this prospective stud...
Reliable prognostic biomarkers are needed to support the early diagnosis of brain injury in extremely preterm infants, and to develop effective neuroprotective protocols that are tailored to the progressing phases of injury. Experimental and clinical research shows that severity of neuronal damage is correlated with changes in the electroencephalog...
The link between cystatin C and mortality independent of glomerular filtration rate (GFR) in adults has prompted the “Shrunken Pore Syndrome” (SPS) hypothesis, where high serum cystatin C with normal creatinine is explained by smaller glomerular pores, through which creatinine can pass freely, while the larger cystatin C, beta-trace protein (BTP) a...
Background
Living kidney transplantation comprises the majority of kidney transplantations in Japan. Living kidney donors should be assured of their own health. Therefore, Japanese guidelines define the criterion of kidney function for living donors. Glomerular filtration rates (GFR) ≥ 70 mL/min/1.73 m ² are required for marginal donors. The guidel...
Citations
... Evaluating drug disposition in critically ill pediatric patients, especially neonates, requires a comprehensive assessment of developmental factors that augment pharmacokinetic complexity. Estimating kidney function in neonates with critical illness is poorly described [21]. Although kidney function develops with maturation, the biomarkers utilized for kidney assessment have inadequate performance in neonates, especially those who are premature or critically ill [22]. ...
Background
In the past decade, there have been substantial advances in our understanding of pediatric AKI. Despite this progress, large gaps remain in our understanding of pharmacology and nutritional therapy in pediatric AKI.
Methods
During the 26th Acute Disease Quality Initiative (ADQI) Consensus Conference, a multidisciplinary group of experts reviewed the evidence and used a modified Delphi process to achieve consensus on recommendations for gaps and advances in care for pharmacologic and nutritional management of pediatric AKI. The current evidence as well as gaps and opportunities were discussed, and recommendations were summarized.
Results
Two consensus statements were developed. (1) High-value, kidney-eliminated medications should be selected for a detailed characterization of their pharmacokinetics, pharmacodynamics, and pharmaco-“omics” in sick children across the developmental continuum. This will allow for the optimization of real-time modeling with the goal of improving patient care. Nephrotoxin stewardship will be identified as an organizational priority and supported with necessary resources and infrastructure. (2) Patient-centered outcomes (functional status, quality of life, and optimal growth and development) must drive targeted nutritional interventions to optimize short- and long-term nutrition. Measures of acute and chronic changes of anthropometrics, body composition, physical function, and metabolic control should be incorporated into nutritional assessments.
Conclusions
Neonates and children have unique metabolic and growth parameters compared to adult patients. Strategic investments in multidisciplinary translational research efforts are required to fill the knowledge gaps in nutritional requirements and pharmacological best practices for children with or at risk for AKI.
... Cystatin C is independent of age and muscle mass and may be promising in this age group. However, it is not yet validated for practice particularly for preterm infants in whom it may be able to screen acute renal insufficiency but not predict the exact level of GFR [14]. It is possible that a combination of biomarkers and physical/physiological characteristics of patients may be necessary for accurate prediction of GFR in young boys with PUV. ...
Objective
To compare the outcomes of pre‐ vs postnatally diagnosed posterior urethral valves (PUV) at two large paediatric centres in North America to ascertain if the prenatal diagnosis of PUV is associated with better outcomes.
Patients and Methods
All boys with PUV were identified at two large paediatric institutions in North America between 2000 and 2020 (The Hospital for Sick Children [SickKids, SK] and Children’s Hospital of Philadelphia [CHOP]). Baseline characteristics and outcome measures were compared between those diagnosed pre‐ vs postnatally. Main outcomes of interest included progression of chronic kidney disease (CKD), the need for renal replacement therapy (RRT), and bladder function compromise, as determined by need for clean intermittent catheterisation (CIC). Time‐to‐event analyses were completed when possible.
Results
During the study period, 152 boys with PUV were treated at the SK (39% prenatal) and 216 were treated at the CHOP (71% prenatal). At the SK, there was no difference between the pre‐ and postnatal groups in the proportion of boys who required RRT, progressed to CKD Stage ≥3, or who were managed with CIC when comparing the timing of diagnosis. The time to event for RRT and CIC was significantly younger for prenatally detected PUV. At the CHOP, significantly more prenatal boys required RRT; however, there was no significant difference in the age this outcome was reached. The proportion of boys managed with CIC was not different but the time to event was significantly earlier in the prenatal group.
Conclusion
This study represents the largest multi‐institutional series of boys with PUV and failed to identify any difference in the outcomes of pre‐ vs postnatal detection of PUV. A multidisciplinary approach with standardisation of the treatment pathways will help in understanding the true impact of prenatal/early detection on outcomes of PUV.
... GFR, at birth, is dependent on both the mass of the nephron, and the gestational age. The development of the kidney (nephrogenesis) continues until week 36 of gestation, and during this time, GFR can be adjusted using different intrauterine methods [10]. We studied prematurity as a risk factor of developing AKI. ...
... Additional endogenous and exogenous biomarkers have been explored, such as creatinine. Creatinine is widely used on all ages, despite its considerable limitations [19,[35][36][37]. Because it comes from creatine and phosphocreatine degradation, creatinine is directly proportional to muscle mass -which is much lower in NBs [8,13,19,37]. ...
... Creatinine is widely used on all ages, despite its considerable limitations [19,[35][36][37]. Because it comes from creatine and phosphocreatine degradation, creatinine is directly proportional to muscle mass -which is much lower in NBs [8,13,19,37]. Creatinine is measured by the well-known colorimetric Jaffe method: an enzymatic assay that may be affected by hyperbilirubinemia, hypertriglyceridemia, and ketonic bodies. Despite its limitations, the Jaffe method remains the most used in clinical practice and scientific research, as it is the ideal method for creatinine analysis [8,19,37,38]. ...
... Creatinine is measured by the well-known colorimetric Jaffe method: an enzymatic assay that may be affected by hyperbilirubinemia, hypertriglyceridemia, and ketonic bodies. Despite its limitations, the Jaffe method remains the most used in clinical practice and scientific research, as it is the ideal method for creatinine analysis [8,19,37,38]. ...
Background
The survival of premature newborns increased in the last decades due to advances in neonatal care. The physiology of this group is still under investigation, once the incomplete organogenesis entails functional particularities that are not yet clarified by current clinical knowledge. The immature kidneys are especially susceptible to acute injury with potential long-term impacts. Current diagnostic parameters of acute kidney injury are limited among the preterm population. The commonly used serum creatinine protein constitutes a poor biomarker to predict early lesions as it is susceptible to several factors, including muscle mass and gestational age.
Objective
The present review explores the evidence on nephrogenesis, renal function, and acute kidney injury in neonatology, as well as studies on renal function biomarkers and their potential application for diagnosis, follow-up, and prognosis in preterm newborns.
Results
Premature newborns reach full-term gestational age with reduced number and quality of nephrons. Consequently, the glomerular filtration rate and tubular function become impaired and are proportional to the gestational age. Despite having a high incidence among the pediatric population, acute kidney injury is still underdiagnosed and poorly managed due to the absence of proper, sensible, and non-invasive biomarkers. Although cystatin C, NGAL, and KIM-1, are promising urinary markers, current literature remains inconsistent.
Conclusion
Further research is needed to properly identify and standardize sensible and specific urinary biomarkers to better assess kidney function in preterm newborns.
... Studies have found that low-level GFR is an independent risk factor for cerebrovascular events. At the same time, some studies have pointed out that the reduction of GFR has a certain correlation with the occurrence and development of cerebrovascular, and the reduction of GFR can be used as a marker of the occurrence of cardiovascular and cerebrovascular diseases [7]. However, there are few studies on the correlation between GFR and the severity of arterial stenosis in patients with ICVD. ...
In order to discuss the segmentation effect of the magnetic resonance angiography (MRA) image segmentation algorithm based on the fuzzy clustering algorithm and DR-CV model and the prognostic value of glomerular filtration rate (GFR) in the ischemic cerebrovascular disease (ICVD), a total of 178 patients who were admitted to the hospital and received MRA due to ICVD were selected as the research objects of this study. Blood vessel segmentation was performed on the MRA image by fuzzy clustering algorithm and DR-CV model, and all patients were divided into a control group (group A), a single-vessel stenosis group (group B), a two-vessel stenosis group (group C), and a multiple-vessel stenosis group (group D). The GFR was estimated by using the dietary modification equation for kidney disease, and the correlation between GFR and the severity of arterial stenosis in patients with ICVD was analyzed. It was found that the results of the Dice similarity index (DSI) of the MRA image blood vessel segmentation algorithm based on the fuzzy clustering algorithm and the integrated model of boundary and regional information (DR-CV model) were all above 85%. The age and GFR values of the four groups of patients were significantly different (P
... m 2 ). This formula performed somewhat better compared to the original neonatal Schwartz formula (15). ...
... Of specific relevance to neonates, steroid administration or hypothyroidism may also affect Cystatin C (16,26). Finally, Cystatin C was not retained in the recently published eGFR formula specific to (pre)term neonates (15). ...
Renal precision medicine in neonates is useful to support decision making on pharmacotherapy, signal detection of adverse (drug) events, and individual prediction of short- and long-term prognosis. To estimate kidney function or glomerular filtration rate (GFR), the most commonly measured and readily accessible biomarker is serum creatinine (Scr). However, there is extensive variability in Scr observations and GFR estimates within the neonatal population, because of developmental physiology and superimposed pathology. Furthermore, assay related differences still matter for Scr, but also exist for Cystatin C. Observations in extreme low birth weight (ELBW) and term asphyxiated neonates will illustrate how renal precision medicine contributes to neonatal precision medicine. When the Kidney Disease Improving Global Outcome (KDIGO) definition of acute kidney injury (AKI) is used, this results in an incidence up to 50% in ELBW neonates, associated with increased mortality and morbidity. However, urine output criteria needed adaptations to broader time intervals or weight trends, while Scr and its trends do not provide sufficient detail on kidney function between ELBW neonates. Instead, we suggest to use assay-specific centile Scr values to better describe postnatal trends and have illustrated its relevance by quantifying an adverse drug event (ibuprofen) and by explaining individual amikacin clearance. Term asphyxiated neonates also commonly display AKI. While oliguria is a specific AKI indicator, the majority of term asphyxiated cases are non-oliguric. Asphyxia results in a clinical significant—commonly transient—mean GFR decrease (−50%) with a lower renal drug elimination. But there is still major (unexplained) inter-individual variability in GFR and subsequent renal drug elimination between these asphyxiated neonates. Recently, the Baby-NINJA (nephrotoxic injury negated by just-in-time action) study provided evidence on the concept that a focus on nephrotoxic injury negation has a significant impact on AKI incidence and severity. It is hereby important to realize that follow-up should not be discontinued at discharge, as there are concerns about long-term renal outcome. These illustrations suggest that integration of renal (patho)physiology into neonatal precision medicine are an important tool to improve contemporary neonatal care, not only for the short-term but also with a positive health impact throughout life.
... In a recent paper published in Pediatric Nephrology, Wilhlelm-Bals et al. [43] revisited the topic of GFR in premature newborn infants. In a vain attempt to define "variables of interest to predict glomerular filtration rate in the first days of life," they used as a standard the plasma disappearance curve of inulin, without validation of the technique. ...
Glomerular filtration rate (GFR) increases progressively throughout fetal life, matures rapidly after birth according to gestational and post-menstrual age, and reaches adult values by 1-year post-natal age. GFR is considered the best marker of kidney function, and in clinical practice, estimated GFR is useful to anticipate complications, establish prognosis, and facilitate treatment decisions. This review article summarizes the maturation of glomerular filtration and the factors and conditions that modulate and impair developing glomerular filtration, and discusses the techniques available to assess GFR in neonates and infants. We focused on simple, reliable, easily available, and cheap techniques to estimate GFR, which may provide valuable information on the renal aspects of the clinical care of this group of patients.
... In this issue of Pediatric Nephrology, Wilhelm-Bals et al. conducted a single-center, prospective study in newborns from Switzerland comparing clearance measured by singleinjection inulin and a new prediction model including weight and creatinine in term and preterm neonates [18]. Those with birth weight < 800 g, hemodynamic instability, and severe anemia were excluded. ...
... The present study also showed a moderate positive correlation of GFR with gestational age and anthropometric parameters. Whereas studies with inulin [33] and serum creatinine [34] demonstrated the correlation between gestational age and GFR, most studies done using Cystatin C have reported contrary findings [35,36]. This finding also suggested the need to considered a new formula for estimate GFR in the newborns that will incorporate anthropometric indices. ...
Background: The value of Cystatin C as a biomarker of Glomerular filtration rate (GFR) among African newborns is unknown, due to paucity of studies, restricting the measurement of GFR in this population of newborns to creatinine clearance despite its limitations. This study was therefore conducted to estimate GFR from serum Cystatin C in a population of Nigerian newborns and explored the relationship with anthropometrics.
Methods: This was a cross-sectional, analytical study. A total of 60 healthy preterm and 30 healthy term babies were recruited at a tertiary hospital in North-central, Nigeria. Serum Cystatin C was determined using ELISA according to standard methods. Anthropometric measurements were done with standard methods. The GFR was estimated using Zappitelli’s equation. Data were analyzed using SPSS Version 20, and p-value < 0.05 was considered significant.
Results: Mean serum Cystatin C was 1.20 ± 0.33 (range 0.80–2.20) mg/L with comparable values in males and females (1.19 ± 0.35 vs 1.15 ± 0.31 mg/L, p = 0.481)). Mean serum Cystatin C among preterm babies were higher than term babies (1.31 ± 0.36 vs 1.01 ± 0.11 mg/L, p = < 0.001). Mean estimated GFR was 65.36 ± 16.9 ml/min/1.73² and was comparable in males and females (64.39 ± 17.95 vs 66.52 ± 15.76 ml/min/1.73 m²,p = 0.555). Estimated GFR was lower among preterm than term babies (60.10 ± 17.53 vs 75.89 ± 9.1 ml/min/1.73 m², p = < 0.001). Serum cystatin C and estimated GFR moderately correlated with gestational age and anthropometrics (length, occipitofrontal circumference and weight).
Conclusions: Serum cystatin C as a biomarker GFR among newborns is low compared with most studies done out of Africa. The serum cystatin C and estimated GFR correlated with the gestational age and anthropometric parameters. The findings relationship between the serum Cystatin C, estimated GFR and anthropometrics among the newborns suggested a need for more studies.
