Harer Matthew W, Pope Chelsea F, Conaway Mark R, Charlton Jennifer R
Division of Neonatology, Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA.
Division of Pediatrics, Department of Radiology, University of Virginia, Charlottesville, VA, USA.
Pediatr Nephrol. 2017 Jun;32(6):1067-1076. doi: 10.1007/s00467-017-3603-x. Epub 2017 Mar 3.
Very low birth weight (VLBW) neonates commonly experience acute kidney injury (AKI) in the neonatal intensive care unit (NICU). We hypothesize that VLBW neonates exposed to AKI in the NICU might be at a higher risk of renal dysfunction during childhood.
In this cohort study, VLBW children (aged 3-7 years) completed a kidney health evaluation and were stratified according to AKI status in the NICU. The primary outcome was renal dysfunction defined as any of the following: estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m, urine protein/creatinine >0.2 or blood pressure ≥95th percentile.
Thirty-four subjects completed the study. Twenty subjects had a history of neonatal AKI (stage 1, n = 8; stage 2, n = 9; and stage 3, n = 3). At a median age of 5 years, the AKI group had a higher risk of renal dysfunction compared with the group without AKI (65% vs 14%, relative risk 4.5 (1.2-17.1), p = 0.01). Overall, 26% of the total cohort had an eGFR <90 mL/min/1.73 m using serum cystatin C (35% of AKI subjects, 14% of no AKI subjects, p = 0.25).
Evidence of renal dysfunction in neonates born VLBW can be found early in childhood. Further work is necessary to determine how to reduce renal disease in this vulnerable population.
极低出生体重（VLBW）新生儿在新生儿重症监护病房（NICU）中常发生急性肾损伤（AKI）。我们推测，在NICU中发生AKI的VLBW新生儿在儿童期发生肾功能障碍的风险可能更高。
在这项队列研究中，VLBW儿童（3至7岁）完成了肾脏健康评估，并根据NICU中的AKI状态进行分层。主要结局是肾功能障碍，定义为以下任何一种情况：估计肾小球滤过率（eGFR）<90 mL/min/1.73 m²、尿蛋白/肌酐>0.2或血压≥第95百分位数。
34名受试者完成了研究。20名受试者有新生儿AKI病史（1期，n = 8；2期，n = 9；3期，n = 3）。在中位年龄5岁时，与无AKI组相比，AKI组发生肾功能障碍的风险更高（65%对14%，相对风险4.5（1.2 - 17.1），p = 0.01）。总体而言，使用血清胱抑素C时，整个队列中有26%的受试者eGFR<90 mL/min/1.73 m²（AKI受试者中为35%，无AKI受试者中为14%，p = 0.25）。
出生时为极低出生体重的新生儿在儿童早期即可发现肾功能障碍的证据。有必要进一步开展工作以确定如何降低这一脆弱人群中的肾脏疾病发生率。
