Matrat Lucie, Ruiz Mathias, Ecochard-Dugelay Emmanuelle, Loras-Duclaux Irène, Marotte Stéphanie, Heissat Sophie, Poinsot Pierre, Sellier-Leclerc Anne-Laure, Bacchetta Justine, Dubourg Laurence, Peretti Noël
Pediatric Gastroenterology Hepatology and Nutrition Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Pierre-Bénite, France.
JPEN J Parenter Enteral Nutr. 2022 Jan;46(1):180-189. doi: 10.1002/jpen.2108. Epub 2021 Apr 22.
Renal dysfunction can complicate home parenteral nutrition (HPN). The aims were, in the context of pediatric HPN, to assess renal function using the measured glomerular filtration rate (mGFR), determine the most accurate formula(s) to estimate GFR, and identify possible underlying mechanisms of renal impairment.
A retrospective study was performed in 2 centers. Patients receiving HPN and aged 2-16 years without medical history of nephropathy were included. GFR was measured using iohexol clearance. Estimated GFR (eGFR) was calculated using creatinine, cystatin C-based, and combined (eGFR ) Schwartz formulas.
A total of 36 patients (18 females) were included; they received HPN for 8 (2-16) years. The primary digestive disease was short-bowel syndrome for 16 (44%) patients, gastrointestinal motility disorder for 10 (28%), or congenital diarrhea for 10 (28%). The median (range) mGFR was 99 (33-136) ml/min/1.73 m ; 9 (25%) patients had mildly decreased mGFR (<90 and ≥60 ml/min/1.73 m ), and 2 (6%) had mildly to severely decreased mGFR (<60 ml/min/1.73 m ). The eGFR formula was the most accurate and precise to estimate GFR. A significant negative correlation between mGFR and PN duration was found for patients receiving PN for 6-7/7 days (P = .008). Activation of the renin-angiotensin system was identified in 15 of 36 (42%) patients.
Renal dysfunction was frequent and correlated with the duration of PN only for patients with the most severe intestinal failure. The use of eGFR improves its detection in these patients. Chronic dehydration may be an underlying mechanism.
肾功能不全可使家庭肠外营养（HPN）复杂化。本研究旨在评估儿科HPN患者的肾功能，采用实测肾小球滤过率（mGFR），确定估算GFR的最准确公式，并识别肾功能损害的潜在机制。
在2个中心进行了一项回顾性研究。纳入接受HPN且年龄在2至16岁、无肾病病史的患者。采用碘海醇清除率测定GFR。使用基于肌酐、胱抑素C以及联合（eGFR）施瓦茨公式计算估算肾小球滤过率（eGFR）。
共纳入36例患者（18例女性）；他们接受HPN治疗8（2至16）年。主要消化系统疾病为短肠综合征16例（44%）、胃肠动力障碍10例（28%）或先天性腹泻10例（28%）。mGFR的中位数（范围）为99（33至136）ml/min/1.73m²；9例（25%）患者mGFR轻度降低（<90且≥60ml/min/1.73m²），2例（6%）患者mGFR轻度至重度降低（<60ml/min/1.73m²）。eGFR公式在估算GFR方面最为准确和精确。接受PN治疗6至7/7天患者的mGFR与PN持续时间之间存在显著负相关（P = 0.008）。36例患者中有15例（42%）发现肾素 - 血管紧张素系统激活。
肾功能不全很常见，仅在最严重的肠衰竭患者中与PN持续时间相关。eGFR的使用可改善对这些患者的检测。慢性脱水可能是潜在机制。
