Roberts Amin J, Belza Christina, Wales Paul W, Courtney-Martin Glenda, Harvey Elizabeth, Avitzur Yaron
Group for Improvement of Intestinal Function and Treatment (GIFT).
Division of Gastroenterology, Hepatology & Nutrition.
J Pediatr Gastroenterol Nutr. 2020 Dec;71(6):789-793. doi: 10.1097/MPG.0000000000002873.
Outcomes of pediatric intestinal failure (PIF) have improved recently, with other comorbidities, such as increased echogenicity/nephrocalcinosis on ultrasound (US) in long-term survivors now evident. We evaluated the significance of nephrocalcinosis over time in PIF and its impact on renal function.
Retrospective analysis on a cohort of PIF patients was performed. Presence of nephrocalcinosis and/or increased renal echogenicity (identified on US), estimated glomerular filtration rate (eGFR; ml · min · 1.73 m2), renal tubular function, PN volume (ml · kg · day) and PN exposure time (hours/day) were reviewed annually over a follow-up period of 2 years. Outcomes in the nephrocalcinosis versus normal US groups were compared.
Forty patients (28 boys, median age 2.7 years) were followed for 2 years. Fifteen (38%) had either increased echogenicity or nephrocalcinosis (group 1) at initial US. US were normal in the remaining 25 (62%) on initial assessment (group 2). eGFR did not differ between group 1 and group 2 at baseline (118 vs 133, P = 0.51) and year 2 (130 vs 131, P = 1.00). The percentage of patients with abnormal markers of tubular function was similar in both groups at year 2 (high urine calcium: creatinine 33 versus 30, P = 0.83; high urine calcium: citrate 39 versus 42, P = 0.87; low urine citrate: creatinine 15 versus 17, P = 1.00; high urine oxalate: creatinine 39 versus 25, P = 0.77).
A large proportion of PIF patients with a history of parenteral nutrition (PN) exposure have nephrocalcinosis and/or increased echogenicity on US. Over a 2-year follow-up period, however, these abnormalities had no impact on eGFR or renal tubular function.
小儿肠衰竭（PIF）的预后近来有所改善，长期存活者出现了其他合并症，如超声（US）显示的回声增强/肾钙质沉着症。我们评估了PIF患者中肾钙质沉着症随时间的意义及其对肾功能的影响。
对一组PIF患者进行回顾性分析。在2年的随访期内，每年复查肾钙质沉着症和/或肾脏回声增强（通过超声确定）、估计肾小球滤过率（eGFR；ml·min·1.73m²）、肾小管功能、肠外营养（PN）量（ml·kg·天）和PN暴露时间（小时/天）。比较肾钙质沉着症组与超声正常组的预后。
40例患者（28例男孩，中位年龄2.7岁）接受了2年的随访。初始超声检查时，15例（38%）出现回声增强或肾钙质沉着症（第1组）。其余25例（62%）初始评估时超声检查正常（第2组）。第1组和第2组在基线时（118对133，P = 0.51）和第2年时（130对131，P = 1.00）的eGFR无差异。两组在第2年时肾小管功能异常标志物的患者百分比相似（高尿钙：肌酐33%对30%，P = 0.83；高尿钙：枸橼酸盐39%对42%，P = 0.87；低尿枸橼酸盐：肌酐15%对17%，P = 1.00；高草酸尿：肌酐39%对25%，P = 0.77）。
很大一部分有肠外营养（PN）暴露史的PIF患者超声显示有肾钙质沉着症和/或回声增强。然而，在2年的随访期内，这些异常对eGFR或肾小管功能没有影响。
