Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Acta Paediatr. 2022 Jun;111(6):1267-1273. doi: 10.1111/apa.16306. Epub 2022 Mar 5.
We have previously found well-maintained renal function in children with new-onset chronic liver disease. In this study, we investigated their renal function during long-term follow-up of the disease.
In a study of 289 children with chronic liver disease, renal function was investigated as glomerular filtration rate (GFR) measured as clearance of inulin or iohexol. Yearly change in GFR was calculated based on a linear mixed model. The data were analysed with regard to different subgroups of liver disease and with regard to the outcome.
The initially well-preserved renal function remained so in most patients during the observation period, even in children with progressive liver disease leading to decompensation. The greatest fall in GFR occurred in patients with initial hyperfiltration. Cholestasis seemed to have a nephroprotective effect.
Chronic liver disease in childhood seems to have less impact on renal function than believed earlier, at least as long as the liver function remains compensated. Regular renal check-ups remain an essential tool for optimal patient care. Hyperfiltration seems to predict decline in renal function. Otherwise no further reliable prognostic markers were found in patients whose liver disease was not decompensated.
我们之前发现新诊断的慢性肝脏疾病患儿的肾功能保持良好。在这项研究中，我们在疾病的长期随访中研究了他们的肾功能。
在一项对 289 名慢性肝脏疾病患儿的研究中，通过检测菊粉或碘海醇清除率来评估肾小球滤过率（GFR）。根据线性混合模型计算 GFR 的年度变化。根据不同的肝脏疾病亚组和结局对数据进行了分析。
在观察期间，大多数患者的初始肾功能保持良好，即使是那些导致失代偿的进行性肝脏疾病的患儿也是如此。GFR 的最大下降发生在初始高滤过的患者中。胆汁淤积似乎具有肾脏保护作用。
与之前的观点相比，儿童慢性肝脏疾病对肾功能的影响似乎较小，至少在肝功能代偿良好的情况下是如此。定期进行肾功能检查仍然是最佳患者护理的重要工具。高滤过似乎预示着肾功能下降。否则，在肝脏疾病没有失代偿的患者中，没有发现其他可靠的预后标志物。
