Glomerular Filtration Rate in Malnourished Children

Abstract

BACKGROUND Glomerular function or kidney function can be affected because of infection or wrong diet (imbalanced nutrients) which is most of the times seen in under nourished or obese children. Like many other organs, kidney also develops in early childhood, especially up to eighteen to twenty four months of life. Malnutrition also is common in six months to two years of life. So, glomerular filtration rate can be affected in this period of life. Malnutrition mostly occurs in low-and middle-income countries. Malnutrition refers to deficiencies, excesses or imbalance in a person's energy and nutrient intake. Nutrition is one of the most important factors that determines growth and size of the human body in childhood. Malnutrition has effect both on renal growth and function of the kidneys. Kidneys serve the excretory and synthetic functions and are important for maintaining the normal homeostasis. We wanted to study the GFR in malnourished children especially who are under nourished as per World Health Organization (WHO) criteria. METHODS72 malnourished children (WHO classification) who met the inclusion criteria were included in this study from June 2017 to May 2018 after taking approval from institutional ethics committee in the department of Paediatrics, Assam Medical College & Hospital. Detailed anthropometric measurements were taken and grading of malnutrition was done according to WHO classification. Serum creatinine was measured for each case. RESULTSMajority of children (68.06%) had severe malnutrition. GFR was normal in 35 (48.61%) cases, decreased in 33 (45.83%) cases, increases in 4 (5.56 %) cases. CONCLUSIONSFrom the study, we can say that approximately 45 % patients having low glomerular filtration rate are malnourished-children, who are under nourished as per World Health Organization (WHO) criteria; but differences in GFR between male and female, and between moderate and severe malnutrition were insignificant (p>0.05).

Association of malnutrition with renal function in children with kidney disease

“…The formation of nephron is completed by 35-36 weeks of gestational age then GFR increased right after birth until 18-20 years. Children older than 3 years old were approximate adult value [4].…”

“…Malnutrition impacts kidney's growth and function as kidney function to do excretory and synthetic function as well as normal homeostasis. The impact is not shown at initial examination of the patient sometimes but further later [4]. Renal function in malnourished children with kidney disease is affected mostly by infection or imbalanced nutrition whether undernourished or over-nourished.…”

“…The serum creatinine is an insensitive way to measure kidney function because it could detect the abnormality if GFR falls by 30-40%. It is affected by sex, height, muscle mass, bilirubin, and not secreted by renal tubules under any conditions [4]. Based on KDIGO 2013, there are 6 stages of chronic kidney disease.…”

“…Pathological mechanism of malnutrition is a complex and multifactorial. In children with chronic kidney disease involved decreased of appetite and nutrient intake, hormonal derangements, metabolic imbalances, inflammation, increased of catabolism, decreased anabolism, and dialysis related abnormalities [4]. The factors that could lead to malnutrition in CKD is a chronic inflammation such as peritonitis, sepsis, or an inadequate protein intake.…”

“…The trend for most of the parameters was for a worsening of nutritional status as the GFR declined. A study in India (2019) compared children between moderate malnutrition and severe malnutrition had the same percentage cases of decreased in GFR [4]. A cohort study in Turkey (2018), with sample of children with kidney disease showed that 45% patients were malnutrition, and more than half were in severe GFR [6].…”