Pediatric Nephrology最新文献

Background: Although use of inhibitors of the renin-angiotensin-aldosterone system (RAAS-I) is contraindicated in the second and third trimesters of pregnancy, a relevant number of pregnancies is still exposed. Fetopathy in children exposed after gestational week (GW) 20 is well described, but data on long-term outcomes are scarce. Our study aims to describe postnatal and long-term outcomes after fetal exposure to RAAS-I.

Methods: We included all pregnancies in the German Pharmacoepidemiological Research Database GePaRD (claims data; 20% of the total German population) with exposure to RAAS-I or the antihypertensives recommended during pregnancy, i.e., metoprolol or methyldopa (HYP) after GW 20. We assessed diagnoses characteristic of RAAS-I-related fetopathy in the first 180 days after birth and examined long-term outcomes of children with and without neonatal fetopathy, especially hypertension and kidney disease.

Results: Overall, we identified 203 live born children exposed to RAAS-I, of whom 61 were exposed to angiotensin II receptor blockers (ARBs), and 29,674 live born children exposed to HYP. Diagnoses consistent with RAAS-I-related fetopathy were seen in eight of the RAAS-I exposed newborns (3.9%) and in seven of the 61 ARB-exposed newborns (11.5%). Median follow-up in children without fetopathy was 4.0 years in both exposure groups. Among non-fetopathy children exposed to RAAS-I, three (1.5%) were diagnosed with hypertension or received antihypertensive prescriptions, compared to 176 children (0.6%) exposed to HYP.

Conclusions: Risk of fetopathy is higher after fetal exposure to ARBs than to angiotensin-converting enzyme inhibitors. In a small proportion of children, sequelae of fetal RAAS-I exposure might only manifest in the years following birth.

Background: Adolescent primary hypertension is associated with decreased neurocognitive performance, a finding suggestive of early target organ damage to the brain. We aimed to determine if adolescent hypertension is associated with altered brain magnetic resonance imaging metrics when compared to normotensive controls.

Methods: Fifty-four newly diagnosed hypertensive subjects and 54 matched controls (age 13-18 years) were studied. All participants had neurocognitive testing and brain MRI to measure cortical thickness and gray matter volume, as well as diffusion metrics to determine white matter microstructural integrity.

Results: The hypertension and control groups showed no significant differences with respect to age, sex, maternal education, income, race, ethnicity, obesity, or laboratory evaluation. While both groups experienced high neighborhood disadvantage, control subjects had higher disadvantage scores (p = 0.03). Adjusted analyses revealed that subjects with hypertension performed similarly to controls on direct neurocognitive testing but received worse parent ratings of executive function. Multivariate analyses found no association between hypertension and brain MRI metrics. However, high neighborhood disadvantage correlated with significantly reduced gray matter volume, and increased BMI z-scores were linked to changes in white matter diffusion metrics but not cortical thickness or gray matter volume.

Conclusions: Adolescent hypertension itself was not directly linked to changes in brain MRI metrics. High neighborhood disadvantage and obesity, both common in adolescents with primary hypertension, were independently associated with altered gray matter volume and white matter microstructure, respectively.

Background: Neonatal acute kidney injury (AKI) is common in infants born extremely preterm (EPT, < 28 weeks' gestation). Neonatal AKI is independently associated with increased mortality and is likely to be associated with kidney dysfunction later in life. This study aimed to describe the epidemiology of AKI in EPT infants in a single tertiary neonatal centre.

Methods: Retrospective study of EPT infants admitted to a tertiary neonatal centre in Australia between August 2020 and December 2022. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) definition (including creatinine and oliguria criteria). Comparisons between AKI and non-AKI cohorts used linear, logistic, or quantile regression.

Results: Of 204 infants admitted during the study period, 193 were included in the study (11 excluded due to death or medical transfer within 48 h after birth). Sixty infants (31%) had an episode of AKI during their inpatient admission: 31 (51.7%) had AKI stage 1, 11 (18.3%) had stage 2, and 18 (30%) had stage 3. Among these, 27 (45%) were recognised by the treating team, 18 (30%) had the diagnosis documented on their discharge summary, and three (5%) were referred for nephrology follow-up. Compared with the non-AKI cohort, infants with AKI were of lower gestational age and lower birth weight and had greater exposure to nephrotoxic medication. Infants with AKI had more episodes of sepsis, more days on respiratory support, and more days admitted to a tertiary centre than those without AKI.

Conclusions: AKI in EPT infants is common and associates with multiple comorbidities and treatments in the NICU. These data highlight risk factors on which AKI screening and stewardship programmes can be focused.

Voiding cystourethrography (VCUG) is indicated for evaluating the anatomy of the urethra and bladder. It is primarily used to diagnose vesicoureteral reflux (VUR) and posterior urethral valves (PUV), especially in cases of febrile urinary tract infections (UTIs), significant ureteral dilation on ultrasound, and-in continent children-urinary symptoms suggestive of infravesical obstruction. VCUG exposes children to a non-negligible dose of radiation and requires urethral catheterization, which can be painful-particularly in males-and carries a low but present risk of post-procedural UTI. Despite its widespread use, VCUG can miss VUR in up to 50% of cases. Moreover, recent studies report that preoperative suspicion of PUV on VCUG was present in only 46% of non-toilet-trained and 59% of toilet-trained males, likely due to challenges in interpreting the VCUG findings. In this review, we will highlight the clinical value, challenges, and areas of debate surrounding this diagnostic test, and offer practical tips to optimize its performance.