Children with Intestinal Failure Maintain Their Renal Function on Long-Term Parenteral Nutrition

Abstract

Background: Long-term parenteral nutrition (PN) has been associated with renal complications, including hypercalciuria, nephrocalcinosis, proteinuria and reduced glomerular filtration rate (GFR). Pediatric data are scarce and mostly short-term. Our study aimed to evaluate renal complications in children with intestinal failure (IF) receiving long-term PN. Methods: A cross-sectional study was performed in a tertiary pediatric IF clinic of patients receiving home-PN treatment for more than 1 year. Data regarding medical background, anthropometrics, laboratory investigations and abdominal sonography were retrieved. Results: Complete data were available for 15 children (67% males), with a median age of 6 (range 1.5–15) years and a median (IQR) PN duration of 4 (1.5–6) years. Low-grade proteinuria was identified in 61% and microalbuminuria in 30% of the cohort. Hypercalciuria and hyperoxaluria were present in 50% and 46%, respectively. One patient had nephrocalcinosis. The estimated GFR was normal in all but one patient who had pre-existing kidney disease. Conclusions: Pediatric IF patients can present with preserved kidney function after years of PN treatment. Despite the high prevalence of hypercalciuria, nephrocalcinosis was not common. Base line and long-term monitoring of various aspects of renal function would be essential to characterize the effects of prolonged PN on kidney functions in pediatric patients.

Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition

“…The duration of PN was inversely correlated with the true GFR (r = −0.66, P < 0.01) (142). More recent observations did not conirm such impaired renal function (143)(144)(145)(146). However, cyclical PN may predispose to disturbed renal function by signiicantly changing the water-electrolyte homeostasis over each 24 hours period with intravascular volume depletion if there are also high intestinal luid losses, hemodynamic instability episodes as well as repeated episodes of dehydration with hypercalcemia that might predispose to nephrocalcinosis or even renal failure (143).…”

“…However, these abnormalities had no impact on estimated glomerular filtration rate (eGFR) or renal tubular function. A recent study concluded that despite the high prevalence of hypercalciuria, nephrocalcinosis was not common (144). Many of these complications are avoidable with, for example maintenance of adequate hydration, regular surveillance of renal function and personalized adjustments of PN managed by a multidisciplinary nutrition support team (144,146).…”

“…A recent study concluded that despite the high prevalence of hypercalciuria, nephrocalcinosis was not common (144). Many of these complications are avoidable with, for example maintenance of adequate hydration, regular surveillance of renal function and personalized adjustments of PN managed by a multidisciplinary nutrition support team (144,146). Base line and long‐term monitoring of various aspects of renal function would be essential to characterize the effects of prolonged PN on kidney function.…”

Fat malabsorption in short bowel syndrome: A review of pathophysiology and management

“…Multidisciplinary intestinal rehabilitation programs have significantly improved the care of patients with SBS 4 . Despite advancement in the management of patients with SBS, treatment with long‐term PN still poses a significant risk for complications, including central line–associated bloodstream infections (CLABSIs), progressive liver disease, electrolyte/fluid disturbances, renal disease, growth failure, and metabolic disease 5 . Indeed, it has been shown that adults with SBS receiving PN who have sepsis and liver dysfunction have a 2–3‐fold increase in mortality compared with the same population without sepsis or liver disease 6 …”