Reference values for renal concentrating capacity in children by the desmopressin test

Mårild, Staffan; Jodal, Ulf; Jonasson, G.; Mangelus, Lena; Odén, Anders; Persson, Nils-Gunnar

doi:10.1007/bf00878361

Cited by 32 publications

(12 citation statements)

References 14 publications

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“…We observed an improvement over time in urine concentration for the whole group, which it may be related to physiologic maturation in the concentrating capacity, or perhaps the parents were more cautious about water-depriving their children when they were older. A study by Marild [40] described osmolarity determinations testing after a stringent overnight fluid deprivation and intranasal desmopressin; that study found a mean urine osmolality of 825 mOsm/kg H 2 O at age 3. Although our fluid deprivation was much less rigorous, the BABY HUG data suggest hydroxyurea treatment preserved urine concentrating ability as evidenced by significant differences in mean urine osmolality and specific gravity and in the proportion of children achieving a urine osmolality >500 mOsm/kg H 2 O between treatment groups.…”

Section: Discussionmentioning

confidence: 99%

Effect of hydroxyurea treatment on renal function parameters: Results from the multi‐center placebo‐controlled BABY HUG clinical trial for infants with sickle cell anemia

Álvarez

Miller

Wang

et al. 2012

Pediatric Blood & Cancer

112

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Background Children with sickle cell anemia (SCA) often develop hyposthenuria and renal hyperfiltration at an early age, possibly contributing to the glomerular injury and renal insufficiency commonly seen later in life. The Phase III randomized double-blinded Clinical Trial of Hydroxyurea in Infants with SCA (BABY HUG) tested the hypothesis that hydroxyurea can prevent kidney dysfunction by reducing hyperfiltration. Procedure 193 infants with SCA (mean age 13.8 months) received hydroxyurea 20 mg/kg/day or placebo for 24 months. 99mTc diethylenetriaminepentaacetic acid (DTPA) clearance, serum creatinine, serum cystatin C, urinalysis, serum and urine osmolality after parent-supervised fluid deprivation, and renal ultrasonography were obtained at baseline and at exit to measure treatment effects on renal function. Results At exit children treated with hydroxyurea had significantly higher urine osmolality (mean 495 mOsm/kg H2O compared to 452 in the placebo group, p=0.007) and a larger percentage of subjects taking hydroxyurea achieved urine osmolality >500 mOsm/kg H2O. Moreover, children treated with hydroxyurea had smaller renal volumes (p=0.007). DTPA-derived glomerular filtration rate (GFR) was not significantly different between the two treatment groups, but was significantly higher than published norms. GFR estimated by the Chronic Kidney Disease in Children Schwartz formula was the best non-invasive method to estimate GFR in these children, as it was the closest to the DTPA-derived GFR. Conclusion Treatment with hydroxyurea for 24 months did not influence GFR in young children with SCA. However, hydroxyurea was associated with better urine concentrating ability and less renal enlargement, suggesting some benefit to renal function.

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Section: Discussionmentioning

confidence: 99%

Effect of hydroxyurea treatment on renal function parameters: Results from the multi‐center placebo‐controlled BABY HUG clinical trial for infants with sickle cell anemia

Álvarez

Miller

Wang

et al. 2012

Pediatric Blood & Cancer

112

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“…The maximum urinary concentrating capacity was expressed as a SD score, which was calculated by the method of Marild et al 12 The glomerular filtration rate was calculated using the formula clearance.5 13 Mann-Whitney's non-parametric test and the x2 test were used for statistical analyses; p <0 05 was considered significant.…”

Section: Methodsmentioning

confidence: 99%

Renal scarring after acute pyelonephritis.

Jakobsson

Berg

Svensson

1994

Archives of Disease in Childhood

270

117

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Seventy six children, 18 boys and 58 girls, aged 0-15 9 (median 1.0) years, with acute pyelonephritis were prospectively studied with a technetium-99m dimercaptosuccinic acid (DMSA) scan during infection and two months later. Fifty nine of these children were also studied two years after the infection. Seventeen Previous studies have shown that renal scarring was almost always associated with vesicoureteric reflux (VUR).9 Later studies using the DMSA scan, however, have suggested that scarring may often occur in the absence of VUR,5 and it has been claimed that renal scarring may be independent of the presence or absence of VUR.10 We therefore need to reassess our knowledge in this field on the basis of studies in which acute pyelonephritis has been diagnosed and followed up with DMSA scans.The aim of this prospective clinical study was to determine the incidence of renal scarring after acute pyelonephritis and how this correlated with previously well known risk factors such as VUR, age, delay in starting treatment, and recurrent urinary tract infections. Patients and methodsSeventy six patients (152 kidneys), 18 boys and 58 girls, aged 0-15-9 (median 1 0) years, consecutively admitted to our hospital with the clinical diagnosis of acute pyelonephritis were studied with a DMSA scan within five days of admission and about two months later. Figure 1 gives the age and sex distributions of the children. Acute pyelonephritis was defined as fever :38 5°C, C reactive protein >20 mg/l, or erythrocyte sedimentation rate >20 mm/hour, and a positive urinary culture. The laboratory data during acute pyelonephritis in most of these children have been published previously.5 All the children were available for long term follow up and a DMSA scan was performed in 59 (78%) of them after two years. The remaining 17 (22%) children had a normal DMSA scan at two months and 11 (65%) of these also had a normal DMSA scan during infection. After the initial treatment, all children received prophylactic antibiotics until the second investigation at two months, and none had a breakthrough infection during that time.

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“…For the next 4 h, all urine samples were collected, and the osmolality of the urine was determined by testing freezing point depression. The concentrating capacity was considered abnormal if the maximum osmolality reached was <525 mosmol/kg at 1 year and <700 mosmol/kg at 2 years [23]. PO 2 , PCO 2 , and pH were determined in capillary blood using electrodes (Chiaron Diagnostics 865, Mijdrecht, The Netherlands).…”

Section: Distal Tubular Functionmentioning

confidence: 99%

Preterm neonates with nephrocalcinosis: natural course and renal function

et al. 2003

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The aim of the study was to evaluate the natural course of nephrocalcinosis (NC) in preterm neonates and the effect of NC on blood pressure and renal glomerular and tubular function. In a prospective observational study of 201 preterm neonates (gestational age <32 weeks) NC was present at term in 83 patients (41%), who were subsequently examined at 6, 12, and 24 months, and until August 2000 annually (with a maximum of 4 years) if NC persisted. Examination consisted of blood pressure measurement, renal ultrasonography, and glomerular and tubular function tests. The probability that NC, when present at term, would persist for 15 and 30 months was 34% [21-45, 95% confidence interval (CI)] and 15% (5-25, 95% CI) (Kaplan-Meier), respectively. Urinary tract infection did not occur more frequently in patients with NC (2.5%) than patients without NC at term (4.4%). Systolic and diastolic blood pressures above the 95th percentile were found in 39% and 48% of patients at 1 year and 30% and 34% at 2 years ( P<0.001). Mean glomerular filtration rate (GFR) (inulin clearance) at 1 and 2 years was 92 and 102 ml/min per 1.73 m(2), respectively. TP/GFR and excretion of alpha(1)-microglobulin were normal. The desmopressin test was impaired in 4 of 30 patients at 1 year and 2 of 25 at 2 years. It was concluded that while proximal tubular function is unaffected in children with neonatal NC, high blood pressure and impaired glomerular and distal tubular function might occur more frequently than in healthy children. Although no relationship can be proven between NC and hypertension or diminished renal function in this study, these results justify a large follow-up study with matched controlled study groups.

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Reference values for renal concentrating capacity in children by the desmopressin test

Cited by 32 publications

References 14 publications

Effect of hydroxyurea treatment on renal function parameters: Results from the multi‐center placebo‐controlled BABY HUG clinical trial for infants with sickle cell anemia

Effect of hydroxyurea treatment on renal function parameters: Results from the multi‐center placebo‐controlled BABY HUG clinical trial for infants with sickle cell anemia

Renal scarring after acute pyelonephritis.

Preterm neonates with nephrocalcinosis: natural course and renal function

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