Évaluation de la fonction rénale chez l’enfant en nutrition parentérale cyclique prolongée

Abstract

Objective. – A few data are available about the influence of long-term parenteral nutrition (PN) on renal function in children. However, the outcome of children with intractable digestive disease in long-term PN is either lifelong PN or small bowel transplantation requiring prolonged administration of nephrotoxic drugs. Therefore, it is important to assess the risk of PN induced nephrotoxicity. The aim of this study was to provide data about glomerular and tubular renal function in children on long-term PN. Patients and Methods. – Twenty-eight patients were studied, aged 10 months to 23 years (mean: 7.5 years), without uropathy, who had received PN for a mean 5.9 years (10 months–16 years). Underlying diseases were: short bowel syndrome (21), functional gut disease (6) and other (1). Blood and urinary samples were used to measure: creatinine, creatinine clearance (CrCl), inuline clearance (InCl) and PAH clearance (PAHCl), microalbuminuria and β2microglobulinuria. Renal ultrasonography was performed. Results. – Creatinine was normal in all the patients. InCl was normal in 75% of the patients. PAHCl was normal in all the studied patients (16). Microalbuminuria and β2microglobulinuria were normal in 17/19 patients. Renal ultrasonography was normal in all the patients. No correlation appeared between InCl and CrCl, neither between the duration of PN and glomerular function. Conclusions. – Renal function being normal in 75% of the population studied, neither the role of PN itself, nor the role of underlying disease, on renal function impairment could be assessed. The InCl appears as the best marker of glomerular function.