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Preterm neonates with nephrocalcinosis: natural course and renal function

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Abstract

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 m2, respectively. TP/GFR and excretion of α1-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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Acknowledgements

This work was supported by the Dutch Kidney Foundation (grant number C97.1672). We thank E. Kuhler, L. Hulshoff, S. Coulier, and A. Moerdijk for their assistance in the collection of data, and nursing and medical colleagues who helped with the collection of samples. We thank L. Wiersma-Deijl for her technical assistance and Dr. J.C.M. Hendriks (Department of Medical Statistics UMC Nijmegen) for calculation of the inulin clearances.

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Authors and Affiliations

  1. Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands

    Eveline A. Schell-Feith, Joana E. Kist-van Holthe, Ronald Brand, Howard M. Berger & Bert J. van der Heijden

  2. Department of Pediatrics, Juliana Children’s Hospital, The Hague, The Netherlands

    Paul H. T. van Zwieten

  3. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    Harmine M. Zonderland

  4. Department of Radiology, Juliana Children’s Hospital, The Hague, The Netherlands

    Herma C. Holscher

  5. Department of Clinical Chemistry, University Medical Center, Nijmegen, The Netherlands

    Dorine W. Swinkels

  6. Department of Pediatrics, Sophia Children’s Hospital, Rotterdam, The Netherlands

    Eveline A. Schell-Feith & Bert J. van der Heijden

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  1. Eveline A. Schell-Feith
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  2. Joana E. Kist-van Holthe
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Correspondence to Eveline A. Schell-Feith.

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Schell-Feith, E.A., Kist-van Holthe, J.E., van Zwieten, P.H.T. et al. Preterm neonates with nephrocalcinosis: natural course and renal function. Pediatr Nephrol 18, 1102–1108 (2003). https://doi.org/10.1007/s00467-003-1235-9

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  • DOI: https://doi.org/10.1007/s00467-003-1235-9

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