Published online March 1, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. 468-475 (doi:10.1542/peds.2006-2639)
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ARTICLE

Is Nephrocalcinosis in Preterm Neonates Harmful for Long-term Blood Pressure and Renal Function?

Joana E. Kist-van Holthe, MD, PhDa, Paul H.T. van Zwieten, MDd, Eveline A. Schell-Feith, MD, PhDf, Harmien M. Zonderland, MD, PhDb, Herma C. Holscher, MD, PhDe, Ron Wolterbeekg, Sylvia Veen, MD, PhDa, Marijke Frolich, PhDc and Bert J. van der Heijden, MD, PhDf

a Departments of Pediatrics
b Radiology
c Clinical Chemistry, Leiden University Medical Center, Leiden, Netherlands
d Departments of Pediatrics
e Radiology, Haga Teaching Hospital, Juliana Children's Hospital, The Hague, Netherlands
f Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
g Department of Medical Statistics, Rijksuniversiteit Leiden, Leiden, Netherlands

OBJECTIVE. The aim of our study was to examine long-term effects of nephrocalcinosis in prematurely born children.

PATIENTS AND METHODS. Preterm neonates (gestational age <32 weeks) with (n = 42) and without (n = 32) nephrocalcinosis were prospectively studied at a mean age of 7.5 (±1.0) years.

RESULTS. Blood pressure did not differ in ex-preterm infants with and without nephrocalcinosis but was significantly higher than expected for healthy children. In comparison to healthy children, more ex-preterm infants with neonatal nephrocalcinosis had (mild) chronic renal insufficiency (glomerular filtration rate: <85 mL/min per 1.73 m2; 6 of 40); this is in contrast to ex-preterm infants without neonatal nephrocalcinosis (2 of 32). Tubular phosphate reabsorption and plasma bicarbonate were significantly lower in children with nephrocalcinosis compared with children without nephrocalcinosis. In addition, more ex-preterm infants with and without nephrocalcinosis than expected had low values for plasma bicarbonate and early-morning urine osmolality compared with healthy children. Kidney length of ex-preterm infants with and without nephrocalcinosis was significantly smaller than expected in healthy children of the same height. Nephrocalcinosis persisted long-term in 4 of 42 children but was not related to blood pressure, kidney length, or renal function.

CONCLUSIONS. Nephrocalcinosis in preterm neonates can have long-term sequelae for glomerular and tubular function. Furthermore, prematurity per se is associated with high blood pressure, relatively small kidneys, and (distal) tubular dysfunction. Long-term follow-up of blood pressure and renal glomerular and tubular function of preterm neonates, especially with neonatal nephrocalcinosis, seems warranted.

Key Words: nephrocalcinosis • renal failure • blood pressure • preterm infants • child

Abbreviations: GFR—glomerular filtration rate • TRP—tubular reabsorption of phosphate • SDS—SD score

Accepted Nov 9, 2006.




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