Glomerular Filtration Rate in Neonates

Guignard, Jean‐Pierre; Gouyon, Jean‐Bernard

doi:10.1016/b978-0-323-53367-6.00007-8

Cited by 3 publications

(1 citation statement)

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“…Additionally, immature kidney tubules in ELBW neonates have poor concentrating ability [28]. As such, these immature and leaky kidney tubules are partially responsible for passive tubular reabsorption of the filtered and accumulated Scr, mostly during the first postnatal days ( Figure S3) [10,29]. The ratio of the amount of creatinine produced versus eliminated over time conceptually illustrates that not acute postnatal kidney function decrease but simply low clearance relative to creatinine production is responsible for the initial rise in Scr after birth.…”

Section: Discussionmentioning

confidence: 99%

Characterizing dynamics of serum creatinine and creatinine clearance in extremely low birth weight neonates during the first 6 weeks of life

et al. 2020

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Background Characterizing the dynamics of serum creatinine concentrations (Scr) and associated creatinine clearance (CLcr) as a measure of kidney function in extremely low birth weight (≤ 1000 g; ELBW) neonates remains challenging. Methods We performed a retrospective study that included longitudinal Scr (enzymatic assay) data from 148 ELBW neonates up to 6 weeks after birth. Change of Scr and inter-individual variability was characterized with nonlinear mixed-effect modeling. Key covariates such as gestational age (GA), mode of delivery (MOD), and treatment with ibuprofen or inotropic agents were investigated. Results A total of 2814 Scr concentrations were analyzed. GA was associated with Scr at birth (higher with advancing GA), and GA and MOD showed an association with postnatal maturation of CLcr (faster clearance increase with advancing GA and after C-section). Small CLcr decrease (≤ 5%) was quantified during ibuprofen treatment. For a GA of 27 weeks, mean Scr (estimated CLcr) at birth was 0.61 mg/dl (0.23 ml/min), increasing to 0.87 mg/dl (0.27 ml/min) at day three, and decreasing to 0.36 mg/dl (0.67 ml/min) at day 42 after birth. Conclusions We report the first mathematical model able to characterize Scr and CLcr in ELBW neonates during the first 6 weeks of life in a quantitative manner as a function of GA, MOD, and ibuprofen treatment. This model allows the derivation of GA-adjusted reference ranges for ELBW neonates and provides a rationale for normative Scr concentrations, and as such will help clinicians to further optimize monitoring and treatment decisions in this vulnerable patient population.

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Section: Discussionmentioning

confidence: 99%