Neonatal kidney size and function in preterm infants: What is a true estimate of glomerular filtration rate?

Carolyn Abitbol, Wacharee Seeherunvong, Marta G. Galarza, Chryso Katsoufis, Denise Francoeur, Marissa Defreitas, Alcia Edwards-Richards, Vimal Master Sankar Raj, Jayanthi Chandar, Shahnaz Duara, Salih Y Yasin, Gaston E Zilleruelo

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

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 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 + 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.

Original languageEnglish
JournalJournal of Pediatrics
Volume164
Issue number5
DOIs
StatePublished - Jan 1 2014

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Glomerular Filtration Rate
Premature Infants
Cystatin C
Kidney
Gestational Age
Creatinine
Arterial Pressure
Inulin
Nephrons
Iothalamic Acid
Iohexol
Serum
Reference Values
Biomarkers
Regression Analysis
Parturition

Keywords

  • Acute kidney injury
  • AKI
  • 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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Neonatal kidney size and function in preterm infants : What is a true estimate of glomerular filtration rate? / Abitbol, Carolyn; Seeherunvong, Wacharee; Galarza, Marta G.; Katsoufis, Chryso; Francoeur, Denise; Defreitas, Marissa; Edwards-Richards, Alcia; Master Sankar Raj, Vimal; Chandar, Jayanthi; Duara, Shahnaz; Yasin, Salih Y; Zilleruelo, Gaston E.

In: Journal of Pediatrics, Vol. 164, No. 5, 01.01.2014.

Research output: Contribution to journalArticle

Abitbol, Carolyn ; Seeherunvong, Wacharee ; Galarza, Marta G. ; Katsoufis, Chryso ; Francoeur, Denise ; Defreitas, Marissa ; Edwards-Richards, Alcia ; Master Sankar Raj, Vimal ; Chandar, Jayanthi ; Duara, Shahnaz ; Yasin, Salih Y ; Zilleruelo, Gaston E. / Neonatal kidney size and function in preterm infants : What is a true estimate of glomerular filtration rate?. In: Journal of Pediatrics. 2014 ; Vol. 164, No. 5.
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title = "Neonatal kidney size and function in preterm infants: What is a true estimate of glomerular filtration rate?",
abstract = "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 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 + 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.",
keywords = "Acute kidney injury, AKI, 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",
author = "Carolyn Abitbol and Wacharee Seeherunvong and Galarza, {Marta G.} and Chryso Katsoufis and Denise Francoeur and Marissa Defreitas and Alcia Edwards-Richards and {Master Sankar Raj}, Vimal and Jayanthi Chandar and Shahnaz Duara and Yasin, {Salih Y} and Zilleruelo, {Gaston E}",
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T1 - Neonatal kidney size and function in preterm infants

T2 - What is a true estimate of glomerular filtration rate?

AU - Abitbol, Carolyn

AU - Seeherunvong, Wacharee

AU - Galarza, Marta G.

AU - Katsoufis, Chryso

AU - Francoeur, Denise

AU - Defreitas, Marissa

AU - Edwards-Richards, Alcia

AU - Master Sankar Raj, Vimal

AU - Chandar, Jayanthi

AU - Duara, Shahnaz

AU - Yasin, Salih Y

AU - Zilleruelo, Gaston E

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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 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 + 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.

AB - 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 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 + 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.

KW - Acute kidney injury

KW - AKI

KW - Cr

KW - Creatinine

KW - CysC

KW - Cystatin C

KW - eGFR

KW - Estimated glomerular filtration rate

KW - GA

KW - Gestational age

KW - GFR

KW - Glomerular filtration rate

KW - iGFR

KW - Inulin glomerular filtration rate

KW - MAP

KW - Mean arterial pressure

KW - SES

KW - Socioeconomic status

KW - TKV

KW - Total kidney volume

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