Urinary lithogenic and inhibitory factors in preterm neonates receiving either total parenteral nutrition or milk formula

Giapros, Vasileios; Papaloukas, A.; Challa, Anna; Nikolopoulos, Panagiotis D.; Tsampoulas, C.; Andronikou, Styliani

doi:10.1007/s00431-003-1209-8

Cited by 5 publications

(7 citation statements)

References 37 publications

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“…Hypercalciuria, e.g., induced by furosemide (and dexamethasone) treatment, plays a major role in the pathophysiology of nephrocalcinosis [9,14]. Furthermore, in the last decade, several urinary lithogenic (oxalate) and inhibitory (citrate, magnesium) substances have been studied as possible modifying factors during the development of renal calcification [15,16,17,18,19].…”

Section: Introductionmentioning

confidence: 99%

Development of nephrocalcinosis in very low birth weight infants

Hein¹,

Richter²,

Manz

et al. 2004

Pediatric Nephrology

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Premature infants undergo intensive growth during the postnatal period. Adequate mineralization is dependent on sufficient intake of calcium (Ca) and phosphorus (P). However, Ca and P supplementation can be associated with some risks, for example development of nephrocalcinosis. We investigated pathophysiological risk factors in premature very low birth weight (VLBW) infants associated with the development of nephrocalcinosis. From June 1994 to September 1995 all preterm neonates with a birth weight below 1,500 g were screened prospectively. At regular intervals of 2 weeks, ultrasonography (US) of the kidneys was performed and parameters of mineral metabolism were assessed in blood and spot urine samples. For analysis, premature infants with nephrocalcinosis (group N) were compared with infants without nephrocalcinosis (group R) and with a retrospectively pair-matched subgroup of premature infants without nephrocalcinosis (control group C) taken from the same study. Nephrocalcinosis was detected in 20 of 114 preterm neonates (group N, 17.5%). Of these 20 infants with nephrocalcinosis, 16 presented with a tendency towards systemic acidosis (pH<7.25) on day 2-7, compared with only 4 of 20 premature infants of the control group. Premature infants of group N had a lower serum P at 2 weeks of life and 5 (versus 0 patients of the control group C) had transient hypophosphatemia (serum P<1.6 mmol/l). Moreover, the Ca/creatinine ratio in spot urine specimens tended to be higher (P<0.1) in patients developing nephrocalcinosis. There were no significant differences in the duration of ventilation, the length of stay in the intensive care unit, and duration and frequency of furosemide and steroid treatment between the groups N and C. VLBW premature infants developing nephrocalcinosis frequently presented with slightly impaired acid-base homoeostasis within the 1st week, followed by signs of impaired mineralization (and immature or impaired renal function) within 2 weeks. In VLBW premature infants, close observation of acid-base status and regular analysis of spot urine specimens (Ca, P, creatinine) during the first weeks of life may help to identify those premature infants at risk for nephrocalcinosis.

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Section: Introductionmentioning

confidence: 99%

Development of nephrocalcinosis in very low birth weight infants

Hein¹,

Richter²,

Manz

et al. 2004

Pediatric Nephrology

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“…It has been demonstrated that breast-fed premature infants have lower Ox/Cr ratios than formula-fed neonates during the first 2 months of life. Giapros and colleagues found a lower urinary Ox/Cr ratio in preterm neonates on total parenteral nutrition than in formula-fed neonates (Giapros et al 2003). Contrary to these results, Hoppe and colleagues found higher oxalic acid excretion in preterm infants under parenteral nutrition (Hoppe et al 1993).…”

Section: Discussionmentioning

confidence: 92%

“…Higher urinary oxalate excretion was observed in formula-fed than in breastfed infants (Campfield et al 1994;Hoppe et al 1997;Morgenstern et al 1993). Parenteral feeding also seems to affect urinary oxalate excretion in preterm and term infants (Giapros et al 2003;Hoppe et al 1993).…”

Section: Introductionmentioning

confidence: 92%

Developmental changes of oxalate excretion in enterally fed preterm infants

Illsinger

Lücke

Vaske³

et al. 2008

J of Inher Metab Disea

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To further substantiate gestational age-related changes in oxalate excretion, we studied urinary oxalate excretion in 66 preterm infants born at 23.4-34.7 weeks of gestation. Spot urine of 66 preterm infants was analysed by ion chromatography as soon as they were completely orally fed with enriched breast milk and/or special preterm milk formula (days 7 to 57 of postnatal life). Infants with evidence of renal, gastrointestinal, muscular or metabolic disease were not included. Newborns on parenteral nutrition were excluded. Oxalate/creatinine ratios (Ox/Cr) decreased with gestational age (three age groups: group 1, 23 0/7-28 0/7; group 2, 28 1/7-32 0/7; and group 3, 32 1/7-35 0/7 weeks of gestation). The mean Ox/Cr was highest in group 1 (398.2 mmol/mol +/- 116.8; n = 21). Differences between groups 1 + 3 were statistically significant; p = 0.001; those between groups 1 + 2 and between groups 2 + 3 were not. Ox/Cr correlated inversely with gestational and maturational age (r = -0.41, p = 0.001; r = -0.33, p = 0.007) and positively with postnatal age (r = 0.32, p = 0.008). It correlated inversely with birth weight as well as actual weight at sample collection (r = -0.46 and -0.44, p < 0.001). Ox/Cr was significantly linked to energy and carbohydrate intake (r = 0.3 and 0.4, p = 0.03 and 0.001). These results were independent of sex. In the present study we show that urinary oxalate excretion in preterm infants depends on gestational age.

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“…Minimal (trophic) enteral nutrition is initiated within the first 48 h of birth. The feeding principle and the amounts of calories, proteins and minerals given by enteral or parenteral nutrition have been reported elsewhere [12]. Detailed information about nutrition was collected at each time point, including information on the quantity and type of formula milk, the duration of breast feeding and whether partial or exclusive and the age at which solid foods were introduced as well as their type and quantities were collected by means of a food questionnaire.…”

Section: Methodsmentioning

confidence: 99%

“…calcium (Ca) and oxalate (Ox)] and stoneinhibiting [e.g. citrate (Cit) and magnesium (Mg)] factors [6][7][8][9][10][11][12]. In the majority of patients, spontaneous resolution of NC occurs in the first years of life, but persistence for several years has been described [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Renal function and kidney length in preterm infants with nephrocalcinosis: a longitudinal study

et al. 2011

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Renal injury in early life may lead to hypertension and renal disease in adulthood. In this prospective study, we estimated renal glomerular and tubular function and kidney length (KL) during the first 2 years of life of preterm infants with nephrocalcinosis (NC) associated with prematurity. The study cohort comprised 107 preterm children, 63 with NC and 44 control subjects without NC who were matched for gender, gestational age and birth weight. Kidney function was estimated based on measurements of serum creatinine (Scr), estimated glomerular filtration rate (eGFR), fractional excretion (FE) of sodium (Na), potassium (K), phosphate (P), magnesium (Mg) and uric acid (UA) and on the ratios of urinary Ca, oxalate (UOx) and citrate (UCit) to urinary creatinine (UCa/Ucr, UOx/Ucr and UCit/Ucr, respectively) calculated from morning urine collections. KL was measured by ultrasonography. Measurements were made at 40 weeks postmenstrual age and at 3, 6, 12 and 24 months of age. At 3 and 6 months, the NC group had higher UCa/Ucr, FEK and FEUA than the control group; at 12 months, only the UCa/Ucr and FEUA was still higher. The UCa/UCit ratio was higher in the NC group. Scr and eGFR did not differ between the groups at any time point. The NC group had a shorter KL up to 12 months of life (left kidney) or 24 months (right kidney). Based on these results, we conclude that NC in the preterm infants enrolled in our study was associated with impaired renal tubular function and a shorter KL in the first year of life.

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Urinary lithogenic and inhibitory factors in preterm neonates receiving either total parenteral nutrition or milk formula

Cited by 5 publications

References 37 publications

Development of nephrocalcinosis in very low birth weight infants

Development of nephrocalcinosis in very low birth weight infants

Developmental changes of oxalate excretion in enterally fed preterm infants

Renal function and kidney length in preterm infants with nephrocalcinosis: a longitudinal study

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