Abstract
Glomerular filtration rate (GFR) increases progressively throughout fetal life, matures rapidly after birth according to gestational and post-menstrual age, and reaches adult values by 1-year post-natal age. GFR is considered the best marker of kidney function, and in clinical practice, estimated GFR is useful to anticipate complications, establish prognosis, and facilitate treatment decisions. This review article summarizes the maturation of glomerular filtration and the factors and conditions that modulate and impair developing glomerular filtration, and discusses the techniques available to assess GFR in neonates and infants. We focused on simple, reliable, easily available, and cheap techniques to estimate GFR, which may provide valuable information on the renal aspects of the clinical care of this group of patients.
Similar content being viewed by others
References
Saint-Faust M, Boubred F, Simeoni U (2014) Renal development and neonatal adaptation. Am J Perinatol 31(9):773–780. https://doi.org/10.1055/s-0033-1361831
Merlet-Bénichou C, Gilbert T, Vilar J, Moreau E, Freund N, Lelièvre-Pégorier M (1999) Nephron number: variability is the rule. Causes and consequences. Lab Investig 79:515–527
Hughson M, Farris AB 3rd, Douglas-Denton R, Hoy WE, Bertram JF (2003) Glomerular number and size in autopsy kidneys: the relationship to birth weight. Kidney Int 63(6):2113–2122. https://doi.org/10.1046/j.1523-1755.2003.00018
Yosypiv IV (2020) Renin-angiotensin system in mammalian kidney development. Pediatr Nephrol 18. https://doi.org/10.1007/s00467-020-04496-5
Ebenezar KK, Wong AK, Smith FG (2012) Haemodynamic responses to angiotensin II in conscious lambs: role of nitric oxide and prostaglandins. Pflugers Arch 463(3):399–404. https://doi.org/10.1007/s00424-011-1065-8
Tóth-Heyn P, Drukker A, Guignard JP (2000) The stressed neonatal kidney: from pathophysiology to clinical management of neonatal vasomotor nephropathy. Pediatr Nephrol 14(3):227–239. https://doi.org/10.1007/s004670050048
Guignard JP, Gouyon JB, John EG (1991) Vasoactive factors in the immature kidney. Pediatr Nephrol 5(4):443–446. https://doi.org/10.1007/bf01453678
Shah P, Riphagen S, Beyene J, Perlman M (2004) Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 89:F152–F155. https://doi.org/10.1136/adc.2002.023093
Bonsante F, Ramful D, Binquet C, Samperiz S, Daniel S, Gouyon JB, Iacobelli S (2019) Low renal oxygen saturation at near-infrared spectroscopy on the first day of life is associated with developing acute kidney injury in very preterm infants. Neonatology 115(3):198–204. https://doi.org/10.1159/000494462
Guignard JP, John EG (1986) Renal function in the tiny, premature infant. Clin Perinatol 13(2):377–401
Bueva A, Guignard JP (1994) Renal function in preterm neonates. Pediatr Res 36:572–577. https://doi.org/10.1203/00006450-199411000-00005
Rhodin MM, Anderson BJ, Peters AM, Coulthard MG, Wilkins B, Cole M, Chatelut E, Grubb A, Veal GJ, Keir MJ, Holford NH (2009) Human renal function maturation: a quantitative description using weight and postmenstrual age. Pediatr Nephrol 24(1):67–76. https://doi.org/10.1007/s00467-008-0997-5
Vampee M, Blennow M, Linné T, Herin P, Aperia A (1992) Renal function in very low birth weight infants: normal maturity reached during early childhood. J Pediatr 121:784–788. https://doi.org/10.1016/s0022-3476(05)81916-x
Schwartz GJ, Furth SL (2007) Glomerular filtration rate measurement and estimation in chronic kidney disease. Pediatr Nephrol 22(11):1839–1948. https://doi.org/10.1007/s00467-006-0358-1
Guignard JP, Torrado A, Da Cunha O, Gautier E (1975) Glomerular filtration rate in the first three weeks of life. J Pediatr 87(2):268–272. https://doi.org/10.1016/s0022-3476(75)80600-7
Fawer CL, Torrado A, Guignard JP (1979) Maturation of renal function in full-term and premature neonates. Helv Paediatr Acta 34(1):11–21
Filler G, Yasin A, Medeiros M (2014) Methods of assessing renal function. Pediatr Nephrol 29(2):183–192. https://doi.org/10.1007/s00467-013-2426-7
Feldman H, Guignard JP (1982) Plasma creatinine in the first month of life. Arch Dis Child 2:123–126. https://doi.org/10.1136/adc.57.2.123
Miall LS, Henderson MJ, Turner AJ, Brownlee KG, Brocklebank JT, Newell SJ, Allgar VL (1999) Plasma creatinine rises dramatically in the first 48 hours of life in preterm infants. Pediatrics 104:e76. https://doi.org/10.1542/peds.104.6.e76
Gallini F, Maggio L, Romagnoli C, Marrocco G, Tortorolo G (2000) Progression of renal function in preterm neonates with gestational age ≤32 weeks. Pediatr Nephrol 15(1-2):119–124. https://doi.org/10.1007/s004670000356
Guignard JP, Drukker A (1999) Why do newborn infants have a high plasma creatinine? Pediatrics 4:e49. https://doi.org/10.1542/peds.103.4.e49
van Goudoever JB, Carnielli V, Darmaun D, Sainz de Pipaon M, ESPGHAN/ESPEN/ESPR/CSPEN working group on pediatric parenteral nutrition (2018) ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Amino acids. Clin Nutr 37(6 Pt B):2315–2323. https://doi.org/10.1016/j.clnu.2018.06.945
Yang S, Lee BS, Park HW, Choi YS, Chung SH, Kim JH, Kim EA, Kim KS (2013) Effect of high vs standard early parenteral amino acid supplementation on the growth outcomes in very low birth weight infants. J Parenter Enter Nutr 37(3):327–334. https://doi.org/10.1177/0148607112456400
Filler G, Guerrero-Kanan R, Alvarez-Elías AC (2016) Assessment of glomerular filtration rate in the neonate : is creatinine the best tool? Curr Opin Pediatr 28(2):173–179. https://doi.org/10.1097/MOP.0000000000000318
Armangil D, Yurdakök M, Canpolat FE, Korkmaz A, Yiğit S, Tekinalp G (2008) Determination of reference values for plasma cystatin C and comparison with creatinine in premature infants. Pediatr Nephrol 23(11):2081–2083. https://doi.org/10.1007/s00467-008-0867-1
Finney H, Newman DJ, Thakkar H, Fell JM, Price CP (2000) Reference ranges for plasma cystatin C and creatinine measurements in premature infants, neonates, and older children. Arch Dis Child 82(1):71–75. https://doi.org/10.1136/adc.82.1.71
Lee JH, Hahn WH, Ahn J, Chang JY, Bae CW (2013) Serum cystatin C during 30 postnatal days is dependent on the postconceptional age in neonates. Pediatr Nephrol 28(7):1073–1078. https://doi.org/10.1007/s00467-013-2429-4
Treiber M, Pecovnik Balon B (2006) Gorenjak M (2006) Cystatin C versus creatinine as a marker of glomerular filtration rate in the newborn. Wien Klin Wochenschr 118(Suppl 2):66. https://doi.org/10.1007/s00508-006-0555-8
Filler G, Lopes L, Harrold J, Bariciak E (2014) β-trace protein may be a more suitable marker of neonatal renal function. Clin Nephrol 81(4):269–276. https://doi.org/10.5414/CN108089
Harmoinen A, Ylinen E, Ala-Houhala M, Janas M, Kaila M, Kouri T (2000) Reference intervals for cystatin C in pre- and full-term infants and children. Pediatr Nephrol 15(1-2):105–108. https://doi.org/10.1007/s004670000421
Koren G, James A, Perlman M (1985) A simple method for the estimation of glomerular filtration rate by gentamicin pharmacokinetics during routine drug monitoring in the newborn. Clin Pharmacol Ther 38(6):680–685. https://doi.org/10.1038/clpt.1985.245
De Cock RF, Allegaert K, Schreuder MF, Sherwin CM, de Hoog M, van den Anker JN, Danhof M, Knibbe CA (2012) Maturation of the glomerular filtration rate in neonates, as reflected by amikacin clearance. Clin Pharmacokinet 51(2):105–117. https://doi.org/10.2165/11595640-000000000-00000
Vieux R, Hascoet JM, Merdariu D, Fresson J, Guillemin F (2010) Glomerular filtration rate reference values in very preterm infants. Pediatrics 125(5):e1186–e1192. https://doi.org/10.1542/peds.2009-1426
Schwartz GJ, Feld LG, Langford DJ (1984) A simple estimate of glomerular filtration rate in full-term infants during the first year of life. J Pediatr 104(6):849–854. https://doi.org/10.1016/s0022-3476(84)80479-5
Brion LP, Fleischman AR, McCarton C, Schwartz GJ (1986) A simple estimate of glomerular filtration rate in low birth weight infants during the first year of life: noninvasive assessment of body composition and growth. J Pediatr 109(4):698–707. https://doi.org/10.1016/s0022-3476(86)80245-1
Haenggi MH, Pelet J, Guignard JP (1999) Estimation of glomerular filtration rate by the formula GFR = K x T/Pc. Arch Pediatr 6(2):165–172. https://doi.org/10.1016/s0929-693x(99)80204-8
Rosenberg SN, Verzo B, Engstrom JL, Kavanaugh K, Meier PP (1992) Reliability of length measurements for preterm infants. Neonatal Netw 11(2):23–27
Treiber M, Pečovnik Balon B, Gorenjak M (2015) A new serum cystatin C formula for estimating glomerular filtration rate in newborns. Pediatr Nephrol 30(8):1297–1305. https://doi.org/10.1007/s00467-014-3029-7
Coulthard MG (1983) Comparison of methods of measuring renal function in preterm babies using inulin. J Pediatr 102(6):923–930. https://doi.org/10.1016/s0022-3476(83)80026-2
van der Heijden AJ, Grose WF, Ambagtsheer JJ, Provoost AP, Wolff ED, Sauer PJ (1988) Glomerular filtration rate in the preterm infant: the relation to gestational and postnatal age. Eur J Pediatr 148(1):24–28. https://doi.org/10.1007/bf00441807
Svenningsen NW (1975) Single injection polyfructosan clearance in normal and asphyxiated neonates. Acta Paediatr Scand 1975 64(1):87–95. https://doi.org/10.1111/j.1651-2227.1975.tb04383.x
Fawer CL, Torrado A, Guignard JP (1979) Single injection clearance in the neonate. Biol Neonate 35(5-6):321–324. https://doi.org/10.1159/000241192
Wilhelm-Bals A, Combescure C, Chehade H, Daali Y, Parvex P (2020) Variables of interest to predict glomerular filtration rate in preterm newborns in the first days of life. Pediatr Nephrol 35(4):703–712. https://doi.org/10.1007/s00467-019-04257-z
Choker G, Gouyon JB (2004) Diagnosis of acute renal failure in very preterm infants. Biol Neonate 86(3):212–216. https://doi.org/10.1159/000079619
Iacobelli S, Bonsante F, Ferdinus C, Labenne M, Gouyon JB (2009) Factors affecting postnatal changes in serum creatinine in preterm infants with gestational age <32 weeks. J Perinatol 29(3):232–236. https://doi.org/10.1038/jp.2008.203
Chowdhary V, Vajpeyajula R, Jain M, Maqsood S, Raina R, Kumar D, Mhanna MJ (2018) Comparison of different definitions of acute kidney injury in extremely low birth weight infants. Clin Exp Nephrol 22(1):117–125. https://doi.org/10.1007/s10157-017-1430-9
Shardlow A, McIntyre NJ, Fraser SDS, Roderick P, Raftery J, Fluck RJ, McIntyre CW, Taal MW (2017) The clinical utility and cost impact of cystatin C measurement in the diagnosis and management of chronic kidney disease: a primary care cohort study. PLoS Med 14(10):e1002400. https://doi.org/10.1371/journal.pmed.1002400
Schreuder MF, Bueters RR, Allegaert K (2014) The interplay between drugs and the kidney in premature neonates. Pediatr Nephrol 29(11):2083–2091. https://doi.org/10.1007/s00467-013-2651-0
Zhao W, Biran V, Jacqz-Aigrain E (2013). Amikacin maturation model as a marker of renal maturation to predict glomerular filtration rate and vancomycin clearance in neonates. Clin Pharmacokinet 52(12):1127–1134. https://doi.org/10.1007/s40262-013-0101-6
Crump C, Sundquist J, Winkleby MA, Sundquist K (2019) Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study. BMJ 365:l1346. https://doi.org/10.1136/bmj.l1346
Acknowledgments
The authors thank Dr Francesco Bonsante for helpful discussion of the manuscript and advice.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Answers:
1. b; 2. a; 3. e; 4. c
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Iacobelli, S., Guignard, JP. Maturation of glomerular filtration rate in neonates and infants: an overview. Pediatr Nephrol 36, 1439–1446 (2021). https://doi.org/10.1007/s00467-020-04632-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-020-04632-1