ESPN 54th Annual Meeting

ESPN 2022


 
Renal function in survivors of hypothermia-treated hypoxic-ischaemic encephalopathy after 10-12 years
KATARINA ROBERTSSON GROSSMANN 3 LIYA VISHNEVSKAYA 2 MATS BLENNOW 3 PETER BARANY 1 MILAN CHROMEK 3

1- KAROLINSKA UNIVERSITY HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- KAROLINSKA UNIVERSITY HOSPITAL, DEPARTMENT OF RADIOLOGY, INTERVENTION UNIT
3- KAROLINSKA INSTITUTET, DEPARTMENT OF CLINICAL SCIENCE, INTERVENTION AND TECHNOLOGY, DIVISION OF PEDIATRICS
 
Introduction:

Therapeutic hypothermia (TH) is standard of care for infants with moderate-severe hypoxic-ischaemic encephalopathy (HIE) in most high-income countries as it reduces the risk of death or severe neurologic disability. Perinatal asphyxia is a common cause of neonatal acute kidney injury (AKI), which remains a frequent complication also in infants treated with TH. Studies on long term renal outcome after TH are scarce. We recently reported that 21% of survivors in our cohort of children with TH-treated HIE had decreased estimated glomerular filtration rate (eGFR) according to the Schwartz-Lyon equation at age 10-12 years. We now sought to investigate renal functions in greater detail in our cohort.

Material and methods:

Our cohort consisted of children born in Stockholm 2007-2009 with a history of TH-treated HIE. At age 10-12, we calculated cystatin C-estimated GFR (cyst C eGFR). Children with decreased cyst C eGFR were examined with iohexol clearance as well. Furthermore, we measured urine-albumin/creatinine ratio in a morning sample, blood pressure (BP) and renal volume on magnetic resonance tomography.

Results:

Forty-eight children participated in the assessment. Five per cent (2/42) had decreased cyst C eGFR, and one child (2% 1/42) had decreased GFR according to iohexol clearance. Microalbuminuria was seen in one child (2%, 1/43), and an elevated office BP in three children (7%, 3/45). Subsequent ambulatory 24-hour BP-measurement revealed high normal BP in one case only (2%, 1/45). No child had hypertension. Mean renal volume was 232.2 cc (SD 40.01, 95% CI 217.7-246.6 cc). There was no difference in any of the parameters between children who had suffered neonatal AKI and those who had not.

Conclusions:

In our cohort, the Schwartz-Lyon equation appears to overestimate the incidence of decreased GFR. Cyst C eGFR and iohexol clearance confirmed a decreased GFR in only 5% and 2% of children, respectively. Albuminuria and elevated BP were rare.