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.
Highlights
Intestinal failure (IF) is commonly defined as a critical reduction in gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth [1].In clinical practice, chronic intestinal failure (IF) is defined by the need for parenteral nutrition (PN) for >60 days due to intestinal disease, dysfunction or resection [2]
Renal complications of long-term PN treatment may include hypercalciuria, nephrocalcinosis, proteinuria and reduced glomerular filtration rate (GFR), which were mostly described in adults [6,7]
This study provides a thorough investigation of potential renal complications among pediatric patients on long-term home PN treatment
Summary
Intestinal failure (IF) is commonly defined as a critical reduction in gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth [1].In clinical practice, chronic IF is defined by the need for PN for >60 days due to intestinal disease, dysfunction or resection [2]. Renal complications of long-term PN treatment may include hypercalciuria, nephrocalcinosis, proteinuria and reduced glomerular filtration rate (GFR), which were mostly described in adults [6,7]. Few pediatric studies have indicated renal impairment in children receiving long-term PN as well, including mainly decreased renal function in early studies [8] and high prevalence of proteinuria or hypercalciuria and nephrocalcinosis [9] in more recent studies [10,11]. Long-term parenteral nutrition (PN) has been associated with renal complications, including hypercalciuria, nephrocalcinosis, proteinuria and reduced glomerular filtration rate (GFR). Our study aimed to evaluate renal complications in children with intestinal failure (IF) receiving long-term PN. Conclusions: Pediatric IF patients can present with preserved kidney function after years of PN treatment. 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
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