Department of Physiology and Pathology, Federal University of Paraíba, Centro de Ciências da Saúde, Campus I, Cidade Universitária, 58051-900, João Pessoa, PB, Brazil.
Department of Medicine, Federal University of São Paulo, Rua Botucatu, 740, 04023-900, São Paulo, SP, Brazil.
Pediatr Nephrol. 2017 Sep;32(9):1555-1563. doi: 10.1007/s00467-017-3602-y. Epub 2017 Feb 23.
The objective of this study was to investigate some biomarkers of renal function and blood pressure in children who had recovered from undernutrition.
This was cross-sectional, comparative study in which a convenience sample of children of both genders (n = 126; age range 6-16 years) treated at the Centre for Nutritional Recovery and Education (São Paulo, Brazil) was used. These children were classified into four groups for analysis: (1) children who were well nourished (control group; n = 50), (2) those showing stunted growth (stunted group; n = 22), (3) those who were underweight (underweight group; n = 23) and (4) those who had recovered from undernutrition (recovered group; n = 31).
No between-group differences were found for mean levels of albuminuria, serum creatinine and cystatin C, and similar mean estimates of glomerular filtration rate (eGFR; using either creatinine, cystatin C or both). Almost 14% of the stunted group, 4% of the underweight group and 3% of the recovered group had albuminuria of >30 mg/g creatinine (chi-square p = 0.034); none of the control children showed albuminuria of >30 mg/g creatinine. Mean systolic (SBP) and diastolic blood pressure (DBP) adjusted for age and gender of the children in the stunted [SBP (95% confidence interval): 92 (88-96) mmHg; DBP: 47 (44-49) mmHg] and recovered [SBP: 93 (90-96) mmHg; DBP: 49 (47-51) mmHg] groups were significantly lower than those of the controls [SBP: 98 (95-100) mmHg, P = 0.027; DBP: 53 (52-55) mmHg, P = 0.001]. After additional adjustment for height, mean DBP remained significantly lower in the recovered group compared with the control group [49 (46-51) vs. 53 (51-55) mmHg, respectively; P = 0.018). Logistic regression analysis showed that the stunted group had a 8.4-fold higher chance of developing albuminuria (>10 mg/g creatinine) than the control children (P = 0.006).
No alterations in renal function were found in underweight children and those who had recovered from undernutrition, whereas children with stunted growth presented with a greater risk for albuminuria. A lower DBP was found in children with stunted growth and those who had recovered from undernutrition.
本研究旨在探讨一些经过营养不良康复治疗的儿童的肾功能和血压的生物标志物。
这是一项横断面、比较研究，使用了巴西圣保罗营养恢复和教育中心治疗的 126 名儿童（男女各 6-16 岁）的便利样本。这些儿童被分为四组进行分析：（1）营养良好的儿童（对照组；n=50）；（2）生长迟缓的儿童（生长迟缓组；n=22）；（3）体重不足的儿童（体重不足组；n=23）；（4）经过营养不良康复治疗的儿童（康复组；n=31）。
各组间白蛋白尿、血清肌酐和胱抑素 C 的平均水平无差异，肾小球滤过率（eGFR）的平均估计值（使用肌酐、胱抑素 C 或两者）也相似。生长迟缓组有近 14%、体重不足组有 4%、康复组有 3%的儿童白蛋白尿 >30mg/g 肌酐（卡方检验，p=0.034）；对照组中没有儿童白蛋白尿 >30mg/g 肌酐。按年龄和性别调整后的生长迟缓组（SBP[95%置信区间]：92（88-96）mmHg；DBP：47（44-49）mmHg）和康复组（SBP：93（90-96）mmHg；DBP：49（47-51）mmHg）儿童的收缩压（SBP）和舒张压（DBP）均显著低于对照组（SBP：98（95-100）mmHg，P=0.027；DBP：53（52-55）mmHg，P=0.001）。在对身高进行进一步调整后，与对照组相比，康复组的平均 DBP 仍显著较低[49（46-51）vs. 53（51-55）mmHg，P=0.018]。逻辑回归分析显示，生长迟缓组儿童发生白蛋白尿（>10mg/g 肌酐）的可能性是对照组儿童的 8.4 倍（P=0.006）。
体重不足的儿童和经过营养不良康复治疗的儿童的肾功能没有改变，而生长迟缓的儿童发生白蛋白尿的风险更高。生长迟缓组和经过营养不良康复治疗的儿童的舒张压较低。
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