Original Article

Pediatric Nephrology

, 24:67

First online:

Human renal function maturation: a quantitative description using weight and postmenstrual age

  • Malin M. RhodinAffiliated withDepartment of Pharmaceutical Biosciences, Division of Pharmacokinetics and Drug Therapy, Faculty of Pharmacy, Uppsala University
  • , Brian J. AndersonAffiliated withDepartment of Anesthesiology, University of AucklandC/-PICU, Auckland Children’s Hospital Email author 
  • , A. Michael PetersAffiliated withDepartment of Applied Physiology, Brighton and Sussex University Hospitals NHS Trust
  • , Malcolm G. CoulthardAffiliated withPaediatric Nephrology, Royal Victoria Infirmary
  • , Barry WilkinsAffiliated withPaediatric Intensive Care Unit, The Children’s Hospital at Westmead
  • , Michael ColeAffiliated withNorthern Institute for Cancer Research, University of Newcastle
  • , Etienne ChatelutAffiliated withEA3035 Université Paul-Sabatier and Institut Claudius-Regaud
  • , Anders GrubbAffiliated withDepartment of Clinical Chemistry, University Hospital
  • , Gareth J. VealAffiliated withNorthern Institute for Cancer Research, University of Newcastle
    • , Michael J. KeirAffiliated withDepartment of Medical Physics, Medical School, University of Newcastle
    • , Nick H. G. HolfordAffiliated withDepartment of Pharmacology and Clinical Pharmacology, University of Auckland

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Abstract

This study pools published data to describe the increase in glomerular filtration rate (GFR) from very premature neonates to young adults. The data comprises measured GFR (using polyfructose, 51Cr-EDTA, mannitol or iohexol) from eight studies (n = 923) and involved very premature neonates (22 weeks postmenstrual age) to adulthood (31 years). A nonlinear mixed effects approach (NONMEM) was used to examine the influences of size and maturation on renal function. Size was the primary covariate, and GFR was standardized for a body weight of 70 kg using an allometric power model. Postmenstrual age (PMA) was a better descriptor of maturational changes than postnatal age (PNA). A sigmoid hyperbolic model described the nonlinear relationship between GFR maturation and PMA. Assuming an allometric coefficient of 3/4, the fully mature (adult) GFR is predicted to be 121.2 mL/min per 70 kg [95% confidence interval (CI) 117–125]. Half of the adult value is reached at 47.7 post-menstrual weeks (95%CI 45.1–50.5), with a Hill coefficient of 3.40 (95%CI 3.03–3.80). At 1-year postnatal age, the GFR is predicted to be 90% of the adult GFR. Glomerular filtration rate can be predicted with a consistent relationship from early prematurity to adulthood. We propose that this offers a clinically useful definition of renal function in children and young adults that is independent of the predictable changes associated with age and size.

Keywords

Allometry Fat-free mass Body composition Glomerular filtration rate Lean body weight Postmenstrual age Renal function